Provider Demographics
NPI:1396596888
Name:AMBROSE, FELIX (CDCA)
Entity type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:AMBROSE
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2508
Mailing Address - Country:US
Mailing Address - Phone:614-987-5003
Mailing Address - Fax:
Practice Address - Street 1:6161 BUSCH BLVD STE 290
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2587
Practice Address - Country:US
Practice Address - Phone:614-987-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.187398101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)