Provider Demographics
NPI:1982049904
Name:WITTE, AMBRE LEI (LCSW)
Entity Type:Individual
Prefix:
First Name:AMBRE
Middle Name:LEI
Last Name:WITTE
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 1:205 GRANITE RUN DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6821
Mailing Address - Country:US
Mailing Address - Phone:717-617-2065
Mailing Address - Fax:717-824-4862
Practice Address - Street 1:205 GRANITE RUN DR
Practice Address - Street 2:SUITE 310
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6821
Practice Address - Country:US
Practice Address - Phone:717-617-2065
Practice Address - Fax:717-824-4862
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0202761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical