Provider Demographics
NPI:1205993144
Name:GERTH-JONES, AMANDA M (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:GERTH-JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:GERTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMSW
Mailing Address - Street 1:229 LOVELY BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY TOP
Mailing Address - State:TN
Mailing Address - Zip Code:37769
Mailing Address - Country:US
Mailing Address - Phone:423-312-2444
Mailing Address - Fax:865-481-6171
Practice Address - Street 1:229 LOVELY BLUFF RD
Practice Address - Street 2:
Practice Address - City:ROCKY TOP
Practice Address - State:TN
Practice Address - Zip Code:37769
Practice Address - Country:US
Practice Address - Phone:423-312-2444
Practice Address - Fax:865-481-6171
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6943104100000X
TN5193104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ080558Medicaid