Provider Demographics
NPI:1780184259
Name:METCALF, AMANDA CHRISTINE (IBCLC, LMHC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:METCALF
Suffix:
Gender:F
Credentials:IBCLC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 INTERNATIONAL PKWY STE 255
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5096
Mailing Address - Country:US
Mailing Address - Phone:407-603-5636
Mailing Address - Fax:
Practice Address - Street 1:1540 INTERNATIONAL PKWY STE 255
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5096
Practice Address - Country:US
Practice Address - Phone:407-603-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
257208174N00000X
FL17828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH18585OtherLICENSED MENTAL HEALTH COUNSELOR
L-302660OtherINTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT
257208OtherACADEMY OF LACTATION POLICY AND PRACTICE