Individual
KELLY CHIPEMBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW-S, LCSW
Contact information
Practice address
673 MDG, 5955 ZEAMER AVE, JBER, AK 99506
(928) 674-7166
Mailing address
673 MDG, 5955 ZEAMER AVE, JBER, AK 99506
(928) 755-4586
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
I.0009969-S
OH
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
10/20/2016
Last updated
09/20/2023
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