Provider Demographics
NPI:1447654884
Name:CHAMBLESS, MICHAEL (LPC, CCMHC, MAC, NCC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CHAMBLESS
Suffix:
Gender:M
Credentials:LPC, CCMHC, MAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-0339
Mailing Address - Country:US
Mailing Address - Phone:912-826-0918
Mailing Address - Fax:912-826-0959
Practice Address - Street 1:108 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-3934
Practice Address - Country:US
Practice Address - Phone:912-826-0918
Practice Address - Fax:912-826-0959
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional