Provider Demographics
NPI:1427588466
Name:PRIOR, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PRIOR
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 1:4985 HOPEWELL MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-4071
Mailing Address - Country:US
Mailing Address - Phone:404-434-4554
Mailing Address - Fax:
Practice Address - Street 1:107 PILGRIM VILLAGE DR
Practice Address - Street 2:BUILDING 200 SUITE C
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9239
Practice Address - Country:US
Practice Address - Phone:407-841-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional