Provider Demographics
NPI:1346563012
Name:CARTER, AMANDA JORDAN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JORDAN
Last Name:CARTER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 MARLEIGH FARM RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6520
Mailing Address - Country:US
Mailing Address - Phone:404-895-9699
Mailing Address - Fax:678-721-2424
Practice Address - Street 1:30C FOX CHASE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2491
Practice Address - Country:US
Practice Address - Phone:678-721-2249
Practice Address - Fax:678-721-2424
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional