Organization · NPI-2

Ambria Page Lcsw

Clinic/Center, Mental Health (Including Community Mental Health Center) · Palm Coast, FL

NPI number1427890243
StatusActive
Last updated in NPPESJun 11, 2024

Details

NPI
1427890243
Entity type
Organization (NPI-2)
Legal business name
Ambria Page Lcsw
Organization subpart
No
Enumeration date
Jun 11, 2024
Certification date
Jun 11, 2024
Last updated
Jun 11, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes

Practice location

4 Office Park Dr Unit 201
Palm Coast, FL 32137-3809

Phone 904-315-9248 · Fax 386-309-2350

Mailing address

4 Office Park Dr Unit 201
Palm Coast, FL 32137-3809

Phone 904-315-9248 · Fax 386-309-2350

Authorized official

Ambria Jacquelyn Page
Provider/Owner/Authorized Person
9043159248

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