Provider Demographics
NPI:1477617835
Name:CHAMBLISS, JUNE MCDANIEL (LCSW PIP)
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:MCDANIEL
Last Name:CHAMBLISS
Suffix:
Gender:F
Credentials:LCSW PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1922
Mailing Address - Country:US
Mailing Address - Phone:251-433-8579
Mailing Address - Fax:251-476-9928
Practice Address - Street 1:601 BEL AIR BLVD
Practice Address - Street 2:SUITE 409
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3513
Practice Address - Country:US
Practice Address - Phone:251-476-9994
Practice Address - Fax:251-476-9928
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPIP0400301C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL49136Medicaid