Healthcare Provider Details

I. General information

NPI: 1639845605
Provider Name (Legal Business Name): CAMDEN CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 AUBURN ST STE 103
PORTLAND ME
04103-6005
US

IV. Provider business mailing address

112 TITAN DR
FLORENCE AL
35630-1197
US

V. Phone/Fax

Practice location:
  • Phone: 207-616-1127
  • Fax:
Mailing address:
  • Phone: 256-275-7089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15584
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: