Provider Demographics
NPI:1083246573
Name:CHAMBERS, DAMON DELANO (LPC)
Entity type:Individual
Prefix:DR
First Name:DAMON
Middle Name:DELANO
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 HANOVER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-2237
Mailing Address - Country:US
Mailing Address - Phone:269-267-8203
Mailing Address - Fax:
Practice Address - Street 1:4621 HANOVER AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-2237
Practice Address - Country:US
Practice Address - Phone:269-267-8203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI640108438101YM0800X
MI6401016633101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty