Provider Demographics
NPI:1932648227
Name:HOWARD, AMANDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MOTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:POST OFFICE BOX 699
Mailing Address - Street 2:100 PRISON ROAD
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918
Mailing Address - Country:US
Mailing Address - Phone:803-625-4607
Mailing Address - Fax:803-625-5262
Practice Address - Street 1:100 PRISON ROAD
Practice Address - Street 2:
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918
Practice Address - Country:US
Practice Address - Phone:803-625-4607
Practice Address - Fax:803-625-5262
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS017457OtherBOARD OF PSYCHOLOGY LICENSE NUMBER