Provider Demographics
NPI:1578050092
Name:CHAMBERS, CHARLES B (LPC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:B
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5800
Mailing Address - Country:US
Mailing Address - Phone:503-440-8853
Mailing Address - Fax:
Practice Address - Street 1:1139 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4129
Practice Address - Country:US
Practice Address - Phone:503-440-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health