Provider Demographics
NPI:1225758220
Name:GOVER-CHAMLOU, AMETISSE NATALIE (LMSW)
Entity Type:Individual
Prefix:
First Name:AMETISSE
Middle Name:NATALIE
Last Name:GOVER-CHAMLOU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 BOLTON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4564
Mailing Address - Country:US
Mailing Address - Phone:703-678-8036
Mailing Address - Fax:
Practice Address - Street 1:344 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1948
Practice Address - Country:US
Practice Address - Phone:844-796-2797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27258104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker