Provider Demographics
NPI:1356073142
Name:UPDEGROVE, AMANDA (RBT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:UPDEGROVE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-6200
Mailing Address - Country:US
Mailing Address - Phone:706-222-1222
Mailing Address - Fax:706-223-1934
Practice Address - Street 1:6003 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6200
Practice Address - Country:US
Practice Address - Phone:706-222-1222
Practice Address - Fax:706-223-1934
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-22-220567106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician