Provider Demographics
NPI:1447796958
Name:CHAMBERLIN, EILEEN (LMSW, CAADC)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:CHAMBERLIN
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 EAGLE RUN DR NE STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7051
Mailing Address - Country:US
Mailing Address - Phone:616-279-3725
Mailing Address - Fax:616-279-3723
Practice Address - Street 1:3210 EAGLE RUN DR NE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7051
Practice Address - Country:US
Practice Address - Phone:616-279-3725
Practice Address - Fax:616-279-3723
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801095461104100000X, 405300000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No405300000XOther Service ProvidersPrevention Professional