Provider Demographics
NPI:1619306867
Name:CHAMBERS, LEE R (LCSW, MAC,CAADC, RAS)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:R
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:LCSW, MAC,CAADC, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 OBRIEN DR
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-5351
Mailing Address - Country:US
Mailing Address - Phone:478-832-9442
Mailing Address - Fax:229-299-0993
Practice Address - Street 1:341 MARGIE DR STE 3A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-832-9442
Practice Address - Fax:229-299-0993
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1303150905101YA0400X
GA509319101YA0400X
GAC0157101YA0400X
OHS.1200490104100000X
1041C0700X
CT82771041C0700X
GACSW0058571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G706472Other821165799
GA9453675OtherAETNA
GA003177727EMedicaid
GA4658124OtherCIGNA
GA003177727BMedicaid