Provider Demographics
NPI:1386867406
Name:MCLEISH, AMANDA A (MA, CCJP, CIS)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:A
Last Name:MCLEISH
Suffix:
Gender:F
Credentials:MA, CCJP, CIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 COUNTY 9 ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OH
Mailing Address - Zip Code:45768
Mailing Address - Country:US
Mailing Address - Phone:740-473-9130
Mailing Address - Fax:
Practice Address - Street 1:2121 7TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3803
Practice Address - Country:US
Practice Address - Phone:304-485-1721
Practice Address - Fax:304-485-6710
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV06-211101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV06-211OtherWV CIS CERTIFICATION
WV06-741OtherWV CCJP CERTIFICATION