Provider Demographics
NPI:1972382695
Name:GOFF, AMBRE SUZANNE (RMHCI)
Entity Type:Individual
Prefix:MS
First Name:AMBRE
Middle Name:SUZANNE
Last Name:GOFF
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3591 KERNAN BLVD S APT 122
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-4647
Mailing Address - Country:US
Mailing Address - Phone:904-207-2781
Mailing Address - Fax:
Practice Address - Street 1:165 WELLS RD STE 304
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3037
Practice Address - Country:US
Practice Address - Phone:904-720-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health