Provider Demographics
NPI:1811600190
Name:AMANDA L PRESTAGE
Entity type:Organization
Organization Name:AMANDA L PRESTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRESTAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-370-1532
Mailing Address - Street 1:703 PALOMAR AIRPORT RD STE 225
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1049
Mailing Address - Country:US
Mailing Address - Phone:951-370-1532
Mailing Address - Fax:442-244-0019
Practice Address - Street 1:703 PALOMAR AIRPORT RD STE 225
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1049
Practice Address - Country:US
Practice Address - Phone:951-370-1532
Practice Address - Fax:442-244-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty