Provider Demographics
NPI:1346447802
Name:SLAUGHTER, AMANDA BROOKE (EDD, LPC, RPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BROOKE
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:EDD, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PROMINENCE CT
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-8953
Mailing Address - Country:US
Mailing Address - Phone:706-265-8224
Mailing Address - Fax:888-447-9197
Practice Address - Street 1:137 PROMINENCE CT
Practice Address - Street 2:SUITE 120
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-8953
Practice Address - Country:US
Practice Address - Phone:706-265-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional