Provider Demographics
NPI:1710505607
Name:SIBRIZZI, AMANDA (LCMHC-A, NCC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SIBRIZZI
Suffix:
Gender:F
Credentials:LCMHC-A, NCC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:SIBRIZZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC-A, NCC
Mailing Address - Street 1:1106 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1516
Mailing Address - Country:US
Mailing Address - Phone:919-805-5395
Mailing Address - Fax:
Practice Address - Street 1:3020 HIGHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1005
Practice Address - Country:US
Practice Address - Phone:919-555-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15825101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health