Provider Demographics
NPI:1760364038
Name:AMBROSE, GABRIELLE SOPHIA (LLMSW)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:SOPHIA
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11949 ASCEND DR
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1126
Mailing Address - Country:US
Mailing Address - Phone:734-306-1463
Mailing Address - Fax:
Practice Address - Street 1:600 S BEACON BLVD STE D
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2178
Practice Address - Country:US
Practice Address - Phone:616-691-6764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851120092104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker