Provider Demographics
NPI:1457703209
Name:STANFORTH, AMANDA JONES (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:JONES
Last Name:STANFORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 GLASCOCK ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1601
Mailing Address - Country:US
Mailing Address - Phone:252-217-9335
Mailing Address - Fax:
Practice Address - Street 1:1100 WAKE FOREST RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1354
Practice Address - Country:US
Practice Address - Phone:919-324-0906
Practice Address - Fax:984-500-1860
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0105381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical