Provider Demographics
NPI:1245580737
Name:D'AMBRISI, MARY FRANCES (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES
Last Name:D'AMBRISI
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 1:12850 HIGHWAY 9 N STE 600-317
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4231
Mailing Address - Country:US
Mailing Address - Phone:678-313-2480
Mailing Address - Fax:
Practice Address - Street 1:12850 HIGHWAY 9 N STE 600-317
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-4231
Practice Address - Country:US
Practice Address - Phone:678-313-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005776101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional