Provider Demographics
NPI:1255137782
Name:NGUYEN, AMANDA MIPHI
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MIPHI
Last Name:NGUYEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7018 ALANBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-6500
Mailing Address - Country:US
Mailing Address - Phone:704-340-4076
Mailing Address - Fax:
Practice Address - Street 1:10150 MALLARD CREEK RD STE 509
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-9708
Practice Address - Country:US
Practice Address - Phone:980-308-4500
Practice Address - Fax:980-458-6037
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0214691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical