Healthcare Provider Details

I. General information

NPI: 1942708433
Provider Name (Legal Business Name): AMBER GROSS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 09/17/2023
Certification Date: 09/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BOWDOIN MILL IS
TOPSHAM ME
04086-1263
US

IV. Provider business mailing address

9 BOWDOIN MILL IS
TOPSHAM ME
04086-1263
US

V. Phone/Fax

Practice location:
  • Phone: 207-835-1032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberCC3952
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMBER GROSS
Title or Position: COUNSELOR
Credential: LCPC
Phone: 207-835-1032