Provider Demographics
NPI:1831288414
Name:GARTH, AMBER MOORE (MS ALC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MOORE
Last Name:GARTH
Suffix:
Gender:F
Credentials:MS ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 KATHY LN SW
Mailing Address - Street 2:PO BX 2239
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1026
Mailing Address - Country:US
Mailing Address - Phone:256-306-4091
Mailing Address - Fax:256-306-4016
Practice Address - Street 1:1615 KATHY LN SW
Practice Address - Street 2:PO BX 2239
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1026
Practice Address - Country:US
Practice Address - Phone:256-306-4091
Practice Address - Fax:256-306-4016
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1202A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health