Provider Demographics
NPI:1255790945
Name:DALLMAN, AMBER ROSE (LCSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:ROSE
Last Name:DALLMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SUN TEMPLE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8621
Mailing Address - Country:US
Mailing Address - Phone:256-874-7364
Mailing Address - Fax:256-954-9046
Practice Address - Street 1:650 SUN TEMPLE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8621
Practice Address - Country:US
Practice Address - Phone:256-874-7364
Practice Address - Fax:256-954-9046
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3864C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical