Provider Demographics
NPI:1881116952
Name:FLYNN, AMBER DEMARR (MA, NCC, LCPC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DEMARR
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MA, NCC, LCPC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:DEMARR
Other - Last Name:MARCELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11766 CARRIAGE HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2267
Mailing Address - Country:US
Mailing Address - Phone:702-510-3908
Mailing Address - Fax:
Practice Address - Street 1:9650 SANTIAGO RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3957
Practice Address - Country:US
Practice Address - Phone:301-596-5759
Practice Address - Fax:410-995-5587
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO.0013580101YP2500X
MDLC7938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty