MEDICARE: MRS. AMBER BANE SENERES LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	9442	NC

General Provider Information

NPI Number	:	1518215987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMBER BANE SENERES LPC

Provider Business Mailing Address
First Line	:	161 PELICAN POINTE DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-7763
Country	:	US
Telephone Number	:	252-619-5451
Fax Number	:

Provider Business Practice Location Address
First Line	:	1241 N ROAD ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3335
Country	:	US
Telephone Number	:	252-500-0534
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	02/21/2019

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