Provider Demographics
NPI:1790382653
Name:WALKER, AMANDA (MA, LCMHC-A, LCAS-A)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MA, LCMHC-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 REVONDA DR
Mailing Address - Street 2:
Mailing Address - City:WOODFIN
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3013
Mailing Address - Country:US
Mailing Address - Phone:919-702-8767
Mailing Address - Fax:
Practice Address - Street 1:4 REVONDA DR
Practice Address - Street 2:
Practice Address - City:WOODFIN
Practice Address - State:NC
Practice Address - Zip Code:28804-3013
Practice Address - Country:US
Practice Address - Phone:919-702-8767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health