Provider Demographics
NPI:1578044186
Name:VIGREUX, AMANDA GAINES (MED, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GAINES
Last Name:VIGREUX
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58344 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-3114
Mailing Address - Country:US
Mailing Address - Phone:985-707-8878
Mailing Address - Fax:
Practice Address - Street 1:59015 AMBER ST STE A3
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5398
Practice Address - Country:US
Practice Address - Phone:985-707-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6324101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor