Provider Demographics
NPI:1770765471
Name:CONERLY, AMANDA GAIL (MS, MSCE, LPC, NCC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAIL
Last Name:CONERLY
Suffix:
Gender:F
Credentials:MS, MSCE, LPC, NCC
Other - Prefix:
Other - First Name:MANDA
Other - Middle Name:GAIL
Other - Last Name:CONERLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, MSCE, LPC, NCC
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-1111
Mailing Address - Country:US
Mailing Address - Phone:601-650-8150
Mailing Address - Fax:601-429-9281
Practice Address - Street 1:907 CARTER AVE STE 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-3645
Practice Address - Country:US
Practice Address - Phone:601-663-2288
Practice Address - Fax:601-429-9281
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health