Provider Demographics
NPI:1386263937
Name:TERRELL, AMBER ROSE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:ROSE
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:DEE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4113 BARCLAY DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-2229
Mailing Address - Country:US
Mailing Address - Phone:901-288-7965
Mailing Address - Fax:
Practice Address - Street 1:17888 67TH CT N
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3275
Practice Address - Country:US
Practice Address - Phone:844-830-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT127861041C0700X
COCSW.099292031041C0700X
FLSW118631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical