Amber Dise Psychiatry and Wellness PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

AMBER DISE PSYCHIATRY AND WELLNESS PLLC

Practice address

9524 Workhouse Rd RM 402
Lorton, VA 22079-2641

Phone

(571) 398-9278

NPI assigned

Jun 10, 2024

Last updated

Jun 10, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Amber Nicole Antoinnette Dise, DNP, PMHNP-BCNPI 1427345867

Title

Nurse Practitioner

Phone

(571) 398-9278

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amber Dise

  • Psychiatric/Mental Health Nurse Practitioner
  • Woodbridge, VA
  • NPI 1427345867
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1508608654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12572 PLYMOUTH CT",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922321",
            "telephone_number": "703-498-7684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9524 WORKHOUSE RD RM 402",
            "city": "LORTON",
            "state": "VA",
            "postal_code": "220792641",
            "telephone_number": "571-398-9278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMBER DISE PSYCHIATRY AND WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "DISE",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "NICOLE ANTOINNETTE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "571-398-9278",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DNP, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.