Provider Demographics
NPI:1205130317
Name:CHAMBERS, CARLA JO (MED, NBCC,LPC)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:JO
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:MED, NBCC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 QUESENBERRY LANE
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17363
Mailing Address - Country:US
Mailing Address - Phone:717-993-6559
Mailing Address - Fax:
Practice Address - Street 1:26 NORTH MAIN STREET, SUITE 5
Practice Address - Street 2:
Practice Address - City:JACOBUS
Practice Address - State:PA
Practice Address - Zip Code:17407
Practice Address - Country:US
Practice Address - Phone:717-817-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional