Provider Demographics
NPI:1790090694
Name:DONOVAN-FISH, AMANDA C (ADDC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:DONOVAN-FISH
Suffix:
Gender:F
Credentials:ADDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 N YORK ST # 230
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3536
Mailing Address - Country:US
Mailing Address - Phone:720-854-0262
Mailing Address - Fax:720-854-0263
Practice Address - Street 1:3840 N YORK ST # 230
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205
Practice Address - Country:US
Practice Address - Phone:720-854-0262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6426101YA0400X
CO101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)