Provider Demographics
NPI:1386038180
Name:LA GUARDIA, AMANDA (PHD, LPCC-S, NCC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:LA GUARDIA
Suffix:
Gender:F
Credentials:PHD, LPCC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 MCMICKEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45221-0001
Mailing Address - Country:US
Mailing Address - Phone:423-676-2298
Mailing Address - Fax:
Practice Address - Street 1:48 E HOLLISTER ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1704
Practice Address - Country:US
Practice Address - Phone:513-556-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1600038-SUPV101YP2500X
TX67303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE.1600038-SUPVOtherCSWMFT