Provider Demographics
NPI:1043837149
Name:LLOYD, AMANDA D (APC, NCC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:LLOYD
Suffix:
Gender:F
Credentials:APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LOG CABIN DR APT 706
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-4121
Mailing Address - Country:US
Mailing Address - Phone:470-503-4764
Mailing Address - Fax:
Practice Address - Street 1:75 LOG CABIN DR APT 706
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-4121
Practice Address - Country:US
Practice Address - Phone:770-410-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health