Provider Demographics
NPI:1750115416
Name:CHAMBERS, MARVIN (LMBT)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N GREENSBORO ST STE C9
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1849
Mailing Address - Country:US
Mailing Address - Phone:919-869-6118
Mailing Address - Fax:
Practice Address - Street 1:200 N GREENSBORO ST STE C9
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1849
Practice Address - Country:US
Practice Address - Phone:919-869-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227009575225700000X
NC14449225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty