Provider Demographics
NPI:1891030060
Name:LANTHRIPP, AMANDA BATES (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BATES
Last Name:LANTHRIPP
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NEAL
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-1827
Mailing Address - Country:US
Mailing Address - Phone:478-445-4817
Mailing Address - Fax:478-445-4963
Practice Address - Street 1:430 N. JEFFERSON ST.
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2606
Practice Address - Country:US
Practice Address - Phone:478-445-4817
Practice Address - Fax:478-445-4963
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW005377104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker