Provider Demographics
NPI:1215604665
Name:COLON, AMANDA V (AMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:V
Last Name:COLON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 W SUNSET BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2180
Mailing Address - Country:US
Mailing Address - Phone:818-221-9170
Mailing Address - Fax:
Practice Address - Street 1:4325 W SUNSET BLVD STE 209
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2180
Practice Address - Country:US
Practice Address - Phone:310-346-1019
Practice Address - Fax:323-798-4416
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114577106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist