Provider Demographics
NPI:1689914558
Name:CUMBO, AMANDA RODGERS (MA, LPCA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RODGERS
Last Name:CUMBO
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6412 BANNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1327
Mailing Address - Country:US
Mailing Address - Phone:704-364-9176
Mailing Address - Fax:
Practice Address - Street 1:6412 BANNINGTON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1327
Practice Address - Country:US
Practice Address - Phone:704-364-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional