Provider Demographics
NPI:1043561491
Name:HEDGES, AMANDA MICHELE
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:MICHELE
Last Name:HEDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5924 CRESTMONT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1334
Mailing Address - Country:US
Mailing Address - Phone:702-684-1497
Mailing Address - Fax:
Practice Address - Street 1:5785 CENTENNIAL CENTER BLVD UNIT 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-7108
Practice Address - Country:US
Practice Address - Phone:702-673-7796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV02515-I101YA0400X
NVCI5336101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)