Provider Demographics
NPI:1902258239
Name:STREET, AMBER (LCSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:STREET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 MAX JETT RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-6265
Mailing Address - Country:US
Mailing Address - Phone:423-502-2869
Mailing Address - Fax:
Practice Address - Street 1:403 PRINCETON RD STE 2
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2040
Practice Address - Country:US
Practice Address - Phone:423-297-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000063341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical