Provider Demographics
NPI:1003422452
Name:HART, AMANDA LEE (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:HART
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 W RIDGE RD STE A204
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1884
Mailing Address - Country:US
Mailing Address - Phone:814-449-6264
Mailing Address - Fax:814-286-6840
Practice Address - Street 1:3939 W RIDGE RD STE A204
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1884
Practice Address - Country:US
Practice Address - Phone:814-449-6264
Practice Address - Fax:814-286-6840
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional