Provider Demographics
NPI:1891937561
Name:DECOSTER, AMBER ROSE (AODA)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:ROSE
Last Name:DECOSTER
Suffix:
Gender:F
Credentials:AODA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 ROYAL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-5426
Mailing Address - Country:US
Mailing Address - Phone:810-580-8730
Mailing Address - Fax:
Practice Address - Street 1:1406 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5804
Practice Address - Country:US
Practice Address - Phone:810-987-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)