Provider Demographics
NPI:1578817151
Name:EARNHARDT, AMANDA (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:EARNHARDT
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-2020
Mailing Address - Country:US
Mailing Address - Phone:704-855-3276
Mailing Address - Fax:704-855-0823
Practice Address - Street 1:417 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023-2533
Practice Address - Country:US
Practice Address - Phone:704-855-3276
Practice Address - Fax:704-855-0823
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9786101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional