Provider Demographics
NPI:1811355167
Name:NELSON, AMANDA (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:SUGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2213 N REYNOLDS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-2501
Mailing Address - Country:US
Mailing Address - Phone:501-847-0081
Mailing Address - Fax:501-847-6905
Practice Address - Street 1:2213 N REYNOLDS RD STE 1
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2501
Practice Address - Country:US
Practice Address - Phone:501-847-0081
Practice Address - Fax:501-847-6905
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7678-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker