Provider Demographics
NPI:1760654172
Name:PASS-TURNER, AMBROES DENICE
Entity Type:Individual
Prefix:
First Name:AMBROES
Middle Name:DENICE
Last Name:PASS-TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 WYNNTON RD STE 124
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-5809
Mailing Address - Country:US
Mailing Address - Phone:706-327-9778
Mailing Address - Fax:
Practice Address - Street 1:2210 WYNNTON RD STE 124
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-5809
Practice Address - Country:US
Practice Address - Phone:706-327-9778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional