Provider Demographics
NPI:1114313053
Name:MARVIN, AMANDA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:MARVIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N GRAHAM HOPEDALE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2990
Mailing Address - Country:US
Mailing Address - Phone:336-513-5504
Mailing Address - Fax:336-513-5593
Practice Address - Street 1:319 N GRAHAM HOPEDALE RD
Practice Address - Street 2:SUITE B
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2990
Practice Address - Country:US
Practice Address - Phone:336-513-5504
Practice Address - Fax:336-513-5593
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0090971041C0700X
NCC0103601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical