Provider Demographics
NPI:1275313751
Name:KISSIAH, AMANDA FARMER
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:FARMER
Last Name:KISSIAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 E HOME AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-3712
Mailing Address - Country:US
Mailing Address - Phone:843-917-0495
Mailing Address - Fax:
Practice Address - Street 1:122 E HOME AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-3712
Practice Address - Country:US
Practice Address - Phone:843-917-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor