Provider Demographics
NPI:1942601505
Name:ROSS, AMANDA CATHERINE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:CATHERINE
Last Name:ROSS
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 1:1970 LARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1542
Mailing Address - Country:US
Mailing Address - Phone:352-207-0405
Mailing Address - Fax:
Practice Address - Street 1:1970 LARKWOOD DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-1542
Practice Address - Country:US
Practice Address - Phone:352-207-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health