Provider Demographics
NPI:1356999601
Name:CHAMBLEE, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:CHAMBLEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 ST JOSEPH AND ROSENDAHL
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-3493
Mailing Address - Country:US
Mailing Address - Phone:678-923-0138
Mailing Address - Fax:
Practice Address - Street 1:9150 ESTATE THOMAS STE 108
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2612
Practice Address - Country:US
Practice Address - Phone:678-923-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1-26593-1B101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty