Provider Demographics
NPI:1861746182
Name:SUNDLAND, AMBER MARIE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:MARIE
Last Name:SUNDLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:WELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9460 DOUBLE R BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-6020
Mailing Address - Country:US
Mailing Address - Phone:775-284-8650
Mailing Address - Fax:775-432-2339
Practice Address - Street 1:5578 LONGLEY LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1825
Practice Address - Country:US
Practice Address - Phone:775-284-8650
Practice Address - Fax:775-284-8654
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6821-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV111156Medicare PIN