Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 6401016633 | MI |
N | 101YS0200X | School Counselor | 6401016633 | MI |
NPI | 1083246573 |
---|---|
Provider Name | Damon Delano Chambers |
First Address | Kalamazoo, MI 49009-2737 |
Second Address | Kalamazoo, MI 49001-3836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2020 |
Last Update Date | 12/02/2020 |