Provider Demographics
NPI:1114658358
Name:WHITLEY, AMANDA LASHELLE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LASHELLE
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:BLACK
Other - Last Name:WHITLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2409 HOMER CLAYTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2207
Mailing Address - Country:US
Mailing Address - Phone:256-582-3203
Mailing Address - Fax:256-582-3216
Practice Address - Street 1:2409 HOMER CLAYTON DRIVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2207
Practice Address - Country:US
Practice Address - Phone:256-582-3203
Practice Address - Fax:256-582-3216
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor