Provider Demographics
NPI:1417544941
Name:SCHMIDT, AMANDA (LGPC, NCC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 AVON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3513
Mailing Address - Country:US
Mailing Address - Phone:301-651-9935
Mailing Address - Fax:
Practice Address - Street 1:4639 FALLS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4914
Practice Address - Country:US
Practice Address - Phone:443-708-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10635101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor