Provider Demographics
NPI:1083998694
Name:WILLIAMS, AMANDA L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 GAY ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3722
Mailing Address - Country:US
Mailing Address - Phone:610-306-4797
Mailing Address - Fax:
Practice Address - Street 1:201 N 4TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1952
Practice Address - Country:US
Practice Address - Phone:610-948-4372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional