Provider Demographics
NPI:1295368421
Name:MADDY, AMANDA DORIS (MA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DORIS
Last Name:MADDY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BAKERS LNDG
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2792
Mailing Address - Country:US
Mailing Address - Phone:703-579-7925
Mailing Address - Fax:
Practice Address - Street 1:177 MIDDLETOWN RD STE 4
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8254
Practice Address - Country:US
Practice Address - Phone:304-367-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional