Provider Demographics
NPI:1912573536
Name:CHAMBERLAIN, TRACY MARIE (CADC II-CA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MARIE
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:CADC II-CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24012 CALLE DE LA PLATA STE 485
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7631
Mailing Address - Country:US
Mailing Address - Phone:949-510-0043
Mailing Address - Fax:949-234-9634
Practice Address - Street 1:24012 CALLE DE LA PLATA STE 485
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7631
Practice Address - Country:US
Practice Address - Phone:949-510-0043
Practice Address - Fax:949-234-9634
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII050300218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)