Healthcare Provider Details

I. General information

NPI: 1386336923
Provider Name (Legal Business Name): DAVID JOHN CHAMBERLAIN JR. LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12851 GRAND RIVER RD
BRIGHTON MI
48116-8506
US

IV. Provider business mailing address

3109 WOODLAND HILLS DR APT 24
ANN ARBOR MI
48108-4208
US

V. Phone/Fax

Practice location:
  • Phone: 810-227-1211
  • Fax:
Mailing address:
  • Phone: 312-731-6308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851116674
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: