Provider Demographics
NPI:1285979609
Name:CHAMBLEE, CHARLES RICHARD JR (DMIN; MDIV; LAC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:CHAMBLEE
Suffix:JR
Gender:M
Credentials:DMIN; MDIV; LAC
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Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-202-7587
Mailing Address - Fax:501-202-7513
Practice Address - Street 1:11321 INTERSTATE 30
Practice Address - Street 2:SUITE 304
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-7067
Practice Address - Country:US
Practice Address - Phone:501-202-7587
Practice Address - Fax:501-202-7513
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA1203022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional