Provider Demographics
NPI:1295123230
Name:LONGIE, AMANDA M (MAPC, MAHR, LADC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:M
Last Name:LONGIE
Suffix:
Gender:F
Credentials:MAPC, MAHR, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3004
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56619-3004
Mailing Address - Country:US
Mailing Address - Phone:218-444-5155
Mailing Address - Fax:218-333-3921
Practice Address - Street 1:403 4TH ST NW
Practice Address - Street 2:SUITE 300
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3142
Practice Address - Country:US
Practice Address - Phone:218-444-5155
Practice Address - Fax:218-333-3291
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304052101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)