Provider Demographics
NPI:1497737688
Name:CHAMBERS, SHELLEY ELIZABETH (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:ELIZABETH
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4063
Mailing Address - Country:US
Mailing Address - Phone:910-254-4545
Mailing Address - Fax:910-254-4557
Practice Address - Street 1:313 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4063
Practice Address - Country:US
Practice Address - Phone:910-254-4545
Practice Address - Fax:910-254-4557
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003199101Y00000X, 103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1234WOtherBCBS
NC6002052Medicaid