Provider Demographics
NPI:1831803394
Name:FIFE, AMANDA MARIE (LCMHCA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:FIFE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HARVEST BLVD
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-0487
Mailing Address - Country:US
Mailing Address - Phone:928-817-2702
Mailing Address - Fax:
Practice Address - Street 1:120 HARVEST BLVD
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-0487
Practice Address - Country:US
Practice Address - Phone:928-323-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health