Provider Demographics
NPI:1083216394
Name:FLANNERY, AMBER JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:JEAN
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 CECIL WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-7432
Mailing Address - Country:US
Mailing Address - Phone:470-464-6124
Mailing Address - Fax:
Practice Address - Street 1:15 JONESBORO ST STE B
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3161
Practice Address - Country:US
Practice Address - Phone:470-205-2665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011880101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health