Provider Demographics
NPI:1982236733
Name:HERSHBERGER, AMANDA ALTHEA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ALTHEA
Last Name:HERSHBERGER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1922
Mailing Address - Country:US
Mailing Address - Phone:423-266-6751
Mailing Address - Fax:
Practice Address - Street 1:7351 COURAGE WAY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1555
Practice Address - Country:US
Practice Address - Phone:423-490-8061
Practice Address - Fax:423-490-8133
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171M00000X, 390200000X
GAMSW010719104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program