Provider Demographics
NPI:1699498394
Name:DULLEA, C AMBER ROSE (LCSW)
Entity type:Individual
Prefix:
First Name:C AMBER
Middle Name:ROSE
Last Name:DULLEA
Suffix:
Gender:X
Credentials:LCSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:ROSE
Other - Last Name:DULLEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9159 NW EGRET ST
Mailing Address - Street 2:
Mailing Address - City:SEAL ROCK
Mailing Address - State:OR
Mailing Address - Zip Code:97376-9709
Mailing Address - Country:US
Mailing Address - Phone:503-810-4163
Mailing Address - Fax:
Practice Address - Street 1:5693 NW PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:SEAL ROCK
Practice Address - State:OR
Practice Address - Zip Code:97376-9638
Practice Address - Country:US
Practice Address - Phone:503-810-4163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL159481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical