Provider Demographics
NPI:1831730456
Name:CHAMBERS, SHIRLEY TATE (LPC)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:TATE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 UPCHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8557
Mailing Address - Country:US
Mailing Address - Phone:770-653-9236
Mailing Address - Fax:
Practice Address - Street 1:1270 UPCHURCH RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-8557
Practice Address - Country:US
Practice Address - Phone:770-653-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008574101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty