Provider Demographics
NPI:1205127263
Name:MARKS, AMANDA L (LAPC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:L
Last Name:MARKS
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2440 SANDY PLAINS RD
Mailing Address - Street 2:BUILDING 13, SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7217
Mailing Address - Country:US
Mailing Address - Phone:770-971-9311
Mailing Address - Fax:678-609-5561
Practice Address - Street 1:2440 SANDY PLAINS RD
Practice Address - Street 2:BUILDING 13, SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7217
Practice Address - Country:US
Practice Address - Phone:770-971-9311
Practice Address - Fax:678-609-5561
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002209101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional