Provider Demographics
NPI:1770289571
Name:ABERNATHY, AMANDA (LICSW-S)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:LICSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 HAYNES RD
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-7364
Mailing Address - Country:US
Mailing Address - Phone:334-451-1826
Mailing Address - Fax:
Practice Address - Street 1:2020 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1614
Practice Address - Country:US
Practice Address - Phone:334-263-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4978C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical