Provider Demographics
NPI:1811305717
Name:CHAMBERS, MARY (CADCI)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94235 MOORE ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-9699
Mailing Address - Country:US
Mailing Address - Phone:541-247-4082
Mailing Address - Fax:541-247-5058
Practice Address - Street 1:29821 COLVIN ST.
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444
Practice Address - Country:US
Practice Address - Phone:541-247-4082
Practice Address - Fax:541-247-5058
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR100306101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)