Provider Demographics
NPI:1255724415
Name:NANTZ, AMANDA (LPCA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NANTZ
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 ARGYLE LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-9285
Mailing Address - Country:US
Mailing Address - Phone:704-682-2654
Mailing Address - Fax:704-255-1801
Practice Address - Street 1:725 CRESCENT RD
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138-7515
Practice Address - Country:US
Practice Address - Phone:704-279-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional