Provider Demographics
NPI:1881187953
Name:CHAMBERLIN, ALETHA DEANDRA (LMSW)
Entity Type:Individual
Prefix:
First Name:ALETHA
Middle Name:DEANDRA
Last Name:CHAMBERLIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 FULLER DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-9763
Mailing Address - Country:US
Mailing Address - Phone:817-773-1364
Mailing Address - Fax:
Practice Address - Street 1:1567 FULLER DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-9763
Practice Address - Country:US
Practice Address - Phone:817-773-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX529461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical