Provider Demographics
NPI:1295075653
Name:MORGAN, AMANDA LUCILLE (BS)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LUCILLE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11315 MISTY ISLE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-9706
Mailing Address - Country:US
Mailing Address - Phone:812-562-0336
Mailing Address - Fax:
Practice Address - Street 1:11315 MISTY ISLE LN
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-9706
Practice Address - Country:US
Practice Address - Phone:812-562-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker