Provider Demographics
NPI:1194867937
Name:CHAMBERS, CAROL ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANNE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26029 ISLAND LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-2161
Mailing Address - Country:US
Mailing Address - Phone:248-594-3364
Mailing Address - Fax:
Practice Address - Street 1:999 HAYNES ST
Practice Address - Street 2:SUITE 250
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6712
Practice Address - Country:US
Practice Address - Phone:248-594-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010141103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical