Provider Demographics
NPI:1851080691
Name:AMBROSE, SASHA RENEE
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:RENEE
Last Name:AMBROSE
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 1:8737 FLETCHER PKWY APT 462
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3236
Mailing Address - Country:US
Mailing Address - Phone:651-323-8855
Mailing Address - Fax:
Practice Address - Street 1:433 CALLAN AVE STE 309
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4641
Practice Address - Country:US
Practice Address - Phone:510-380-6146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health