Provider Demographics
NPI:1780300277
Name:SHANK, AMANDA K (LGSW)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:K
Last Name:SHANK
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 AIKENS CTR STE 304
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-6201
Mailing Address - Country:US
Mailing Address - Phone:681-781-7752
Mailing Address - Fax:
Practice Address - Street 1:261 AIKENS CTR STE 304
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-6201
Practice Address - Country:US
Practice Address - Phone:681-781-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00944825104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker