Provider Demographics
NPI:1912699422
Name:SIEVERS-MARKS, AMANDA JOY (APCC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:SIEVERS-MARKS
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 TETON DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-1045
Mailing Address - Country:US
Mailing Address - Phone:260-515-2283
Mailing Address - Fax:
Practice Address - Street 1:1445 TETON DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-1045
Practice Address - Country:US
Practice Address - Phone:260-515-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC13874101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor