Provider Demographics
NPI:1780424762
Name:BOYLES, AMANDA ROBERSON (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ROBERSON
Last Name:BOYLES
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 MYRTLE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4688
Mailing Address - Country:US
Mailing Address - Phone:912-690-3700
Mailing Address - Fax:
Practice Address - Street 1:326 MYRTLE CROSSING DR
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4688
Practice Address - Country:US
Practice Address - Phone:912-489-7590
Practice Address - Fax:912-489-3877
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YS0200X
GALPC013072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool