Provider Demographics
NPI:1841765419
Name:LUTZ, AMANDA THOMAS (LPA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:THOMAS
Last Name:LUTZ
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CHARLOTTE HWY STE E
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8681
Mailing Address - Country:US
Mailing Address - Phone:828-333-5708
Mailing Address - Fax:828-484-1025
Practice Address - Street 1:204 CHARLOTTE HWY STE E
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8681
Practice Address - Country:US
Practice Address - Phone:828-333-5708
Practice Address - Fax:828-484-1025
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5487103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist