Provider Demographics
NPI:1043828676
Name:AMBERG, SARAH (LPC, LAC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:AMBERG
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4432
Mailing Address - Country:US
Mailing Address - Phone:858-682-7236
Mailing Address - Fax:
Practice Address - Street 1:356 1/2 MAIN ST # 5
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5527
Practice Address - Country:US
Practice Address - Phone:720-583-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001471101YA0400X
COLPC.0016341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)