Provider Demographics
NPI:1801824230
Name:BOYLES, AMANDA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:BOYLES
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 1:3000 SOUTLAKE PARK SUITE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244
Mailing Address - Country:US
Mailing Address - Phone:205-987-0724
Mailing Address - Fax:205-987-0725
Practice Address - Street 1:3000 SOUTLAKE PARK SUITE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-987-0724
Practice Address - Fax:205-987-0725
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1895 G1041C0700X
AL2021C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51524123OtherBCBS