Provider Demographics
NPI:1295197374
Name:WAMBERG, JAMAINE (LMHC TEMP, NCC)
Entity type:Individual
Prefix:
First Name:JAMAINE
Middle Name:
Last Name:WAMBERG
Suffix:
Gender:F
Credentials:LMHC TEMP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 COURT ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1919
Mailing Address - Country:US
Mailing Address - Phone:712-252-3871
Mailing Address - Fax:712-252-3157
Practice Address - Street 1:3320 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103
Practice Address - Country:US
Practice Address - Phone:712-202-0777
Practice Address - Fax:712-202-0780
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15055101YA0400X
IA079318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)