Provider Demographics
NPI:1598132755
Name:BRANDENBURG, AMANDA CUMMINGS (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CUMMINGS
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 OAK GROVE PL
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-0224
Mailing Address - Country:US
Mailing Address - Phone:704-439-6583
Mailing Address - Fax:
Practice Address - Street 1:5122 OAK GROVE PL
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-0224
Practice Address - Country:US
Practice Address - Phone:704-439-6583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4831103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling