Provider Demographics
NPI:1659138659
Name:DAVIS, AMANDA NICHOLE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICHOLE
Last Name:DAVIS
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 1:14 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROCK CITY FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12863-1238
Mailing Address - Country:US
Mailing Address - Phone:518-598-4521
Mailing Address - Fax:
Practice Address - Street 1:135 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4532
Practice Address - Country:US
Practice Address - Phone:518-584-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health