Provider Demographics
NPI:1952948143
Name:SMITH, AMANDA CAROL (MSE, BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CAROL
Last Name:SMITH
Suffix:
Gender:
Credentials:MSE, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 ALDERSGATE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3364
Practice Address - Country:US
Practice Address - Phone:980-423-1210
Practice Address - Fax:980-938-2722
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1-20-40708103K00000X
106S00000X
NC2325103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician