Provider Demographics
NPI:1417044975
Name:DERHEIMER, AMANDA MARIE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:DERHEIMER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5996 DRENTA CIR SW
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-8609
Mailing Address - Country:US
Mailing Address - Phone:330-447-2356
Mailing Address - Fax:
Practice Address - Street 1:250 ORION ST NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8375
Practice Address - Country:US
Practice Address - Phone:330-966-1007
Practice Address - Fax:330-966-1008
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 0008305101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health