=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144183542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMB COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 MARKET ST STE 1A
-----------------------------------------------------
City | SOUTH PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106-3646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-410-6268
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 MARKET ST STE 1A
-----------------------------------------------------
City | SOUTH PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106-3646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-410-6268
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL COUNSELOR
-----------------------------------------------------
Name | AMANDA MARIE BUCCI
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 207-408-5186
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------