Provider Demographics
NPI:1538828785
Name:CHAMBERS, JANESSA JEAN
Entity type:Individual
Prefix:
First Name:JANESSA
Middle Name:JEAN
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 1:317 CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4801
Mailing Address - Country:US
Mailing Address - Phone:919-777-0214
Mailing Address - Fax:919-777-0212
Practice Address - Street 1:317 CHATHAM ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4801
Practice Address - Country:US
Practice Address - Phone:919-777-0214
Practice Address - Fax:919-777-0212
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0170201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical