Provider Demographics
NPI:1659153971
Name:ADGATE, AMANDA HAVILL (MA, LMHC, LCMHC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:HAVILL
Last Name:ADGATE
Suffix:
Gender:F
Credentials:MA, LMHC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 LOCHSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-6469
Mailing Address - Country:US
Mailing Address - Phone:352-638-2281
Mailing Address - Fax:
Practice Address - Street 1:1251 LOCHSHIRE LN
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-6469
Practice Address - Country:US
Practice Address - Phone:352-638-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13791101YM0800X
NC14476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health