Provider Demographics
NPI:1275893851
Name:STUART, AMANDA JERRUSIA (MSW, LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JERRUSIA
Last Name:STUART
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 QUARTERS LANDING CIR APT 602
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-8318
Mailing Address - Country:US
Mailing Address - Phone:707-601-3387
Mailing Address - Fax:
Practice Address - Street 1:416 W. RIDGE ST.
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:NC
Practice Address - Zip Code:28458
Practice Address - Country:US
Practice Address - Phone:910-289-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0063931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical