Provider Demographics
NPI:1821116435
Name:CIAMBRUSCHINI, AMELIA CAROLYN (LPC)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:CAROLYN
Last Name:CIAMBRUSCHINI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:CAROLYN
Other - Last Name:FRETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:11260 ROGER BACON DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5227
Mailing Address - Country:US
Mailing Address - Phone:703-435-7401
Mailing Address - Fax:703-435-7402
Practice Address - Street 1:11260 ROGER BACON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5227
Practice Address - Country:US
Practice Address - Phone:703-435-7401
Practice Address - Fax:703-435-7402
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health