Provider Demographics
NPI:1780198937
Name:CHERRY, AMANDA PAIGE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:PAIGE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-9114
Mailing Address - Country:US
Mailing Address - Phone:713-334-4134
Mailing Address - Fax:
Practice Address - Street 1:2420 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9114
Practice Address - Country:US
Practice Address - Phone:713-334-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX545801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical