Provider Demographics
NPI:1205525581
Name:FAIN, AMANDA L (MSW LGSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:FAIN
Suffix:
Gender:F
Credentials:MSW LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 28TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-1008
Mailing Address - Country:US
Mailing Address - Phone:304-208-1145
Mailing Address - Fax:
Practice Address - Street 1:924 28TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-1008
Practice Address - Country:US
Practice Address - Phone:304-208-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor