Provider Demographics
NPI:1770960155
Name:EVANS, AMANDA (LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CRISWELL DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17007-9695
Mailing Address - Country:US
Mailing Address - Phone:717-856-7568
Mailing Address - Fax:
Practice Address - Street 1:365 CRISWELL DR
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17007-9695
Practice Address - Country:US
Practice Address - Phone:717-856-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health