Provider Demographics
NPI:1053099564
Name:KINNEY, AMBRIEL (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:AMBRIEL
Middle Name:
Last Name:KINNEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 SADDLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-8188
Mailing Address - Country:US
Mailing Address - Phone:662-809-6397
Mailing Address - Fax:
Practice Address - Street 1:612 SADDLE CREEK DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-8188
Practice Address - Country:US
Practice Address - Phone:662-809-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC10613101YM0800X, 1041C0700X
TN93731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health