Provider Demographics
NPI:1962801290
Name:WARE, AMBER SAMANTHA (BA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:SAMANTHA
Last Name:WARE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:SAMANTHA
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 CAPITOLA DR STE 310
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4497
Mailing Address - Country:US
Mailing Address - Phone:910-673-8513
Mailing Address - Fax:
Practice Address - Street 1:100 CAPITOLA DR STE 310
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4497
Practice Address - Country:US
Practice Address - Phone:910-673-8513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12114101YP2500X
WACG60501010101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor