Provider Demographics
NPI:1194033951
Name:GOPAL, AMANDA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:GOPAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 RIDGEFIELD BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-6211
Mailing Address - Country:US
Mailing Address - Phone:828-670-7723
Mailing Address - Fax:828-670-7727
Practice Address - Street 1:1100 RIDGEFIELD BLVD STE 190
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-6211
Practice Address - Country:US
Practice Address - Phone:828-670-7723
Practice Address - Fax:828-670-7727
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0066541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical