Doctor Name: | MS. PATRICIA ANN CHAMP |
NPI Number: | 1932221090 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC, LADC 1 |
License Number: | 4936 , 269 |
Business Practice Address: | 20 Forsythe Ave S Yarmouth, MA - 026641814 |
Business Phone Number: | 5083985155 |
Business Fax Number: | 5083983478 |
Mailing Address: | 116 Brook Rd, PLYMOUTH |
State: | MA |
Postal Code: | 023606330 |
Phone Number: | 5082245668 |
Fax Number: | |
NPI Enumeration Date: | 04/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 4936 , 269 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |