Provider Demographics
NPI:1295334795
Name:CHATHAM BEHAVIORAL LLC
Entity type:Organization
Organization Name:CHATHAM BEHAVIORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MACK
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:912-412-2532
Mailing Address - Street 1:6605 ABERCORN ST STE 101F
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5896
Mailing Address - Country:US
Mailing Address - Phone:912-412-2532
Mailing Address - Fax:
Practice Address - Street 1:6605 ABERCORN ST STE 101F
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5896
Practice Address - Country:US
Practice Address - Phone:912-412-2532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty