Provider Demographics
NPI:1417462805
Name:HAMPTON, AMANDA MARCEDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARCEDA
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 E WHITEAKER AVE
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-1648
Mailing Address - Country:US
Mailing Address - Phone:541-767-3823
Mailing Address - Fax:
Practice Address - Street 1:508 E WHITEAKER AVE
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-1648
Practice Address - Country:US
Practice Address - Phone:541-767-3823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor