Provider Demographics
NPI:1255223632
Name:CHURCH, AMBER LEE (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LEE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4018 CHESMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-5008
Mailing Address - Country:US
Mailing Address - Phone:202-643-1838
Mailing Address - Fax:
Practice Address - Street 1:9500 MEDICAL CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3703
Practice Address - Country:US
Practice Address - Phone:202-288-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator