Healthcare Provider Details

I. General information

NPI: 1184254450
Provider Name (Legal Business Name): CAROLYN ANNE CHAMBERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W MAIN ST
SAINT CLAIRSVILLE OH
43950-1040
US

IV. Provider business mailing address

30800 CHAGRIN BLVD
PEPPER PIKE OH
44124-5925
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-9447
  • Fax:
Mailing address:
  • Phone: 216-591-0324
  • Fax: 216-591-1243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2103720
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: