Provider Demographics
NPI:1891116968
Name:HANNAH, AMANDA (LMHC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HANNAH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 KNIGHT BOXX RD
Mailing Address - Street 2:STE 1
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7395
Mailing Address - Country:US
Mailing Address - Phone:904-379-8675
Mailing Address - Fax:
Practice Address - Street 1:43 KNIGHT BOXX RD
Practice Address - Street 2:STE 1
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7395
Practice Address - Country:US
Practice Address - Phone:904-379-8675
Practice Address - Fax:904-423-0490
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12220101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health