Provider Demographics
NPI:1326476185
Name:LIFSEY, AMANDA PAIGE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:PAIGE
Last Name:LIFSEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8598 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38225-2308
Mailing Address - Country:US
Mailing Address - Phone:731-364-5675
Mailing Address - Fax:731-364-2870
Practice Address - Street 1:8598 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:TN
Practice Address - Zip Code:38225-2308
Practice Address - Country:US
Practice Address - Phone:731-364-5675
Practice Address - Fax:731-364-2870
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61941041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017488Medicaid