Provider Demographics
NPI:1245366095
Name:LANCE- SEXTON, AMANDA (MFT, ATR-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LANCE- SEXTON
Suffix:
Gender:F
Credentials:MFT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1407
Mailing Address - Country:US
Mailing Address - Phone:619-293-7246
Mailing Address - Fax:619-293-0360
Practice Address - Street 1:4307 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1407
Practice Address - Country:US
Practice Address - Phone:619-293-7246
Practice Address - Fax:619-293-0360
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41964106H00000X
ATR-BC 03-127174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174400000XOther Service ProvidersSpecialist