Provider Demographics
NPI:1548384423
Name:CHAMBLISS, PERNILLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PERNILLE
Middle Name:
Last Name:CHAMBLISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 33RD PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3302
Mailing Address - Country:US
Mailing Address - Phone:202-686-1486
Mailing Address - Fax:202-237-1498
Practice Address - Street 1:1400 20TH ST NW
Practice Address - Street 2:SUITE 103
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5906
Practice Address - Country:US
Practice Address - Phone:202-686-1486
Practice Address - Fax:202-237-1498
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical