Provider Demographics
NPI:1992825939
Name:OVEROCKER, AMANDA JOAN (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JOAN
Last Name:OVEROCKER
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MS
Other - First Name:MANDIE
Other - Middle Name:JOAN
Other - Last Name:OVEROCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:3824 BLAIRWOOD STREET
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27265
Mailing Address - Country:US
Mailing Address - Phone:336-202-2582
Mailing Address - Fax:336-574-1139
Practice Address - Street 1:425 SPRING GARDEN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2733
Practice Address - Country:US
Practice Address - Phone:336-379-0199
Practice Address - Fax:336-574-1139
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6516101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103620Medicaid