Provider Demographics
NPI:1215385216
Name:MACOR, AMANDA (AMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MACOR
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MELINDA
Other - Last Name:LAWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3860 BLACKHAWK RD STE 140
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4832
Mailing Address - Country:US
Mailing Address - Phone:925-984-2326
Mailing Address - Fax:
Practice Address - Street 1:3860 BLACKHAWK RD STE 140
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4832
Practice Address - Country:US
Practice Address - Phone:925-984-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101402390200000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program