Individual
MR. MARK AMBROSIOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COUNSELOR INTERN
Contact information
Practice address
950 N 4TH ST, LONGVIEW, TX 75601-5436
(903) 758-0596
Mailing address
PO BOX 6800, LONGVIEW, TX 75608-6800
(903) 758-2471
(903) 234-1639
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6598
TX
Other
Enumeration date
01/13/2012
Last updated
01/13/2012
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