Healthcare Provider Details

I. General information

NPI: 1477617835
Provider Name (Legal Business Name): JUNE MCDANIEL CHAMBLISS LCSW PIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BEL AIR BLVD SUITE 409
MOBILE AL
36606-3513
US

IV. Provider business mailing address

400 MICHIGAN AVE
MOBILE AL
36604-1922
US

V. Phone/Fax

Practice location:
  • Phone: 251-476-9994
  • Fax: 251-476-9928
Mailing address:
  • Phone: 251-433-8579
  • Fax: 251-476-9928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPIP0400301C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: