Provider Demographics
NPI:1417352329
Name:CHAMBERLAIN, NICHOLAS (LCSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CRISPIN CT STE 203D
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8205
Mailing Address - Country:US
Mailing Address - Phone:828-250-3700
Mailing Address - Fax:828-250-3701
Practice Address - Street 1:10 CRISPIN CT STE 203D
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8205
Practice Address - Country:US
Practice Address - Phone:828-250-3700
Practice Address - Fax:828-250-3701
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0091531041C0700X
NCC0105621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical