Provider Demographics
NPI:1528800935
Name:RUTKOWSKI, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FRANCES
Other - Middle Name:AMBER
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FRANCES AMBER BROOKS
Mailing Address - Street 1:2519 HABERSHAM DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-5654
Mailing Address - Country:US
Mailing Address - Phone:404-932-0131
Mailing Address - Fax:
Practice Address - Street 1:1900 THE EXCHANGE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2022
Practice Address - Country:US
Practice Address - Phone:404-233-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty