Provider Demographics
NPI:1760356927
Name:AMBROSE, PAMELA D
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18043 RED MULBERRY RD
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2967
Mailing Address - Country:US
Mailing Address - Phone:571-989-8123
Mailing Address - Fax:571-989-8123
Practice Address - Street 1:18043 RED MULBERRY RD
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2967
Practice Address - Country:US
Practice Address - Phone:571-989-8123
Practice Address - Fax:571-989-8123
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701015399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty