Provider Demographics
NPI:1538629985
Name:CHAMBERS, MARCIA ANN
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:ANN
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 BADGER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5047
Mailing Address - Country:US
Mailing Address - Phone:907-669-0123
Mailing Address - Fax:907-385-0633
Practice Address - Street 1:1076 BADGER RD
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-5047
Practice Address - Country:US
Practice Address - Phone:907-669-0123
Practice Address - Fax:907-385-0633
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1-15-18221103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst