Provider Demographics
NPI:1952469496
Name:CHAMBERS, ANDREA MICHAELE (LMSW ACSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHAELE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6070 FENTON RD
Mailing Address - Street 2:STE 3
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4747
Mailing Address - Country:US
Mailing Address - Phone:810-720-5258
Mailing Address - Fax:
Practice Address - Street 1:6070 FENTON RD
Practice Address - Street 2:STE 3
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4747
Practice Address - Country:US
Practice Address - Phone:810-720-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010645701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11573823OtherCAQH
MI0897438OtherBCBS
MI100724OtherVALUE OPTIONS
MIOPO9870Medicare ID - Type Unspecified