Provider Demographics
NPI:1518344696
Name:CHRISTIAN, AMANDA JEAN (MS, LPC, LMHP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JEAN
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:MS, LPC, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MEADOWVIEW LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-5706
Mailing Address - Country:US
Mailing Address - Phone:276-618-2249
Mailing Address - Fax:
Practice Address - Street 1:1600 MEADOWVIEW LN
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-5706
Practice Address - Country:US
Practice Address - Phone:276-618-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health