Provider Demographics
NPI:1669084745
Name:GARDIA, AMANDA MARIE
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MARIE
Last Name:GARDIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 EIGHTH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2235
Mailing Address - Country:US
Mailing Address - Phone:888-376-6246
Mailing Address - Fax:
Practice Address - Street 1:1231 EIGHTH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2235
Practice Address - Country:US
Practice Address - Phone:888-376-6246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC15611101YP2500X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional