Provider Demographics
NPI:1326361064
Name:MWANZA, AMANDA LEIGH (LMSW)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEIGH
Last Name:MWANZA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3025 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-2538
Mailing Address - Country:US
Mailing Address - Phone:254-214-2631
Mailing Address - Fax:
Practice Address - Street 1:4800 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1329
Practice Address - Country:US
Practice Address - Phone:254-214-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53073104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker