Provider Demographics
NPI:1982478004
Name:CZOSTKOWSKI, AMANDA (LLPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CZOSTKOWSKI
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51928 BOLAND RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3150
Mailing Address - Country:US
Mailing Address - Phone:586-219-7953
Mailing Address - Fax:
Practice Address - Street 1:42590 STEPNITZ DR
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3161
Practice Address - Country:US
Practice Address - Phone:586-954-1838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023209101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)