Provider Demographics
NPI:1891909883
Name:SHOVER, AMANDA KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:SHOVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:FINCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4253 N CROSSOVER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4593
Mailing Address - Country:US
Mailing Address - Phone:479-521-5731
Mailing Address - Fax:479-521-6520
Practice Address - Street 1:2003 SE WALTON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3725
Practice Address - Country:US
Practice Address - Phone:479-464-8081
Practice Address - Fax:479-464-0674
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1814-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical