Provider Demographics
NPI:1417522236
Name:CHAMBERS, ROY IV (ALC)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:CHAMBERS
Suffix:IV
Gender:M
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2184 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35214-1839
Mailing Address - Country:US
Mailing Address - Phone:205-566-9375
Mailing Address - Fax:
Practice Address - Street 1:1728 5TH AVE N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-2023
Practice Address - Country:US
Practice Address - Phone:205-502-7278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3765A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor