Provider Demographics
NPI:1750692547
Name:TIMMONS, AMBRAYA (MSW, P-LCSW)
Entity type:Individual
Prefix:
First Name:AMBRAYA
Middle Name:
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:MSW, P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:BISCOE
Mailing Address - State:NC
Mailing Address - Zip Code:27209-9587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:318 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-3018
Practice Address - Country:US
Practice Address - Phone:910-576-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP005692101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor