Provider Demographics
NPI:1730423815
Name:MOIR-BROW, AMBER C (LCSW, ACADC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:C
Last Name:MOIR-BROW
Suffix:
Gender:F
Credentials:LCSW, ACADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SUGAR MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-9740
Mailing Address - Country:US
Mailing Address - Phone:208-946-7333
Mailing Address - Fax:208-625-2066
Practice Address - Street 1:30410 HIGHWAY 200
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-9601
Practice Address - Country:US
Practice Address - Phone:208-946-7333
Practice Address - Fax:208-625-2066
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACADC101YA0400X
IDLCSW-38293104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID104100000XOtherSOCIAL WORKER