Provider Demographics
NPI:1669990743
Name:FORT, AMBER (LMFT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:FORT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RIVER POINT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-3719
Mailing Address - Country:US
Mailing Address - Phone:678-882-9726
Mailing Address - Fax:
Practice Address - Street 1:2376 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4492
Practice Address - Country:US
Practice Address - Phone:770-609-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000427101YM0800X
GAMFT001638101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health