Provider Demographics
NPI:1740847524
Name:MBATA-GRAHAM, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MBATA-GRAHAM
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 1:3886 LITTLE CREEK CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-9536
Mailing Address - Country:US
Mailing Address - Phone:919-521-2057
Mailing Address - Fax:
Practice Address - Street 1:4920 WINDY HILL DR STE 14B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5193
Practice Address - Country:US
Practice Address - Phone:984-212-4619
Practice Address - Fax:252-600-0454
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0134531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical