Provider Demographics
NPI:1720714868
Name:PRESLEY, AMANDA BLAIR (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BLAIR
Last Name:PRESLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:
Other - Last Name:PRESLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:225 CASTLEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7798
Mailing Address - Country:US
Mailing Address - Phone:501-733-6410
Mailing Address - Fax:
Practice Address - Street 1:225 CASTLEBERRY DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7798
Practice Address - Country:US
Practice Address - Phone:501-733-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2150-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical