Provider Demographics
NPI:1285977728
Name:AMBERSON, MINDI MARLENA (LBSW, ALC)
Entity type:Individual
Prefix:MRS
First Name:MINDI
Middle Name:MARLENA
Last Name:AMBERSON
Suffix:
Gender:F
Credentials:LBSW, ALC
Other - Prefix:MRS
Other - First Name:MINDI
Other - Middle Name:MARLENA
Other - Last Name:WILKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW, ALC
Mailing Address - Street 1:244 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-6439
Mailing Address - Country:US
Mailing Address - Phone:256-294-3549
Mailing Address - Fax:
Practice Address - Street 1:244 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-6439
Practice Address - Country:US
Practice Address - Phone:256-294-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2073A101YP2500X
AL4285B104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker