Provider Demographics
NPI:1669691804
Name:GORMAN, AMANDA LEA
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEA
Last Name:GORMAN
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 1:478 DOVER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1827
Mailing Address - Country:US
Mailing Address - Phone:615-975-6869
Mailing Address - Fax:
Practice Address - Street 1:3310 PERIMETER HILL DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4123
Practice Address - Country:US
Practice Address - Phone:615-250-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health