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Organization

AMBER DISE PSYCHIATRY AND WELLNESS PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. AMBER NICOLE ANTOINNETTE DISE DNP, PMHNP-BC (NURSE PRACTITIONER)
(571) 398-9278
Entity
Organization

Contact information

Practice address
9524 WORKHOUSE RD RM 402, LORTON, VA 22079-2641
(571) 398-9278
Mailing address
12572 PLYMOUTH CT, WOODBRIDGE, VA 22192-2321
(703) 498-7684

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
261QM0850X
Adult Mental Health Clinic/Center
261QM0855X
Adolescent and Children Mental Health Clinic/Center

Other

Enumeration date
06/10/2024
Last updated
06/10/2024
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