Provider Demographics
NPI:1053813808
Name:DOBLER, AMANDA ROLLINS (MS, NCC, LMHC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROLLINS
Last Name:DOBLER
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:ROLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 HUGHES ST NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4455
Mailing Address - Country:US
Mailing Address - Phone:850-243-0095
Mailing Address - Fax:
Practice Address - Street 1:107 HUGHES ST NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4455
Practice Address - Country:US
Practice Address - Phone:850-243-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH16308101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH17266OtherLICENSED MENTAL HEALTH COUNSELOR