Provider Demographics
NPI:1225764657
Name:PRESTAGE, AMANDA LYNN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:PRESTAGE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 SPINNAKER ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4676
Mailing Address - Country:US
Mailing Address - Phone:760-576-8299
Mailing Address - Fax:
Practice Address - Street 1:703 PALOMAR AIRPORT RD STE 225
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1049
Practice Address - Country:US
Practice Address - Phone:951-370-1532
Practice Address - Fax:951-370-1532
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133792106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist