Provider Demographics
NPI:1093158099
Name:WHIPPO, AMANDA ROSE (LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:WHIPPO
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ROSE
Other - Last Name:CARON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:528 SABATTUS RD
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-4110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:528 SABATTUS RD
Practice Address - Street 2:
Practice Address - City:SABATTUS
Practice Address - State:ME
Practice Address - Zip Code:04280-4110
Practice Address - Country:US
Practice Address - Phone:207-847-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional