Individual
WAYNE CHAMBERLAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPSS, CDCA
Contact information
Practice address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Mailing address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.173104
OH
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
741
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0439292
—
OH
Enumeration date
11/14/2018
Last updated
06/06/2021
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