Provider Demographics
NPI:1114524741
Name:SHARP, AMANDA JO (LICDC, LPC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JO
Last Name:SHARP
Suffix:
Gender:F
Credentials:LICDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S MAIN STREET, SUITE 210
Mailing Address - Street 2:P.O. BOX 21
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2911
Mailing Address - Country:US
Mailing Address - Phone:419-807-1054
Mailing Address - Fax:
Practice Address - Street 1:130 S MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2911
Practice Address - Country:US
Practice Address - Phone:419-807-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103522101YM0800X
OHLICDC.162234101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health