Provider Demographics
NPI:1821414103
Name:DEVOLLD, AMANDA (MED, LPCC-S, LCDCIII)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DEVOLLD
Suffix:
Gender:F
Credentials:MED, LPCC-S, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 SUNFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-9671
Mailing Address - Country:US
Mailing Address - Phone:614-394-6047
Mailing Address - Fax:
Practice Address - Street 1:1225 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3094
Practice Address - Country:US
Practice Address - Phone:855-692-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDC.121001-3101YA0400X
OHE.1000376-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)