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NPI Code Detail

MEDICARE: AMANDA LEE PIERCE I CDCA

MEDICARE: AMANDA LEE PIERCE I CDCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor173401OH
2171M00000XCase Manager/Care Coordinator
3101YA0400XAddiction (Substance Use Disorder) Counselor179353OH

General Provider Information

NPI Number : 1285132001
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA LEE PIERCE I CDCA
Provider Business Mailing Address
First Line : 8145 N MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45415-1703
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2400 W STROOP RD
Second Line :
City : DAYTON
State : OH
Zip : 45439-2041
Country : US
Telephone Number : 937-701-7599
Fax Number : 937-630-4482
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2018
Last Update Date : 01/05/2023

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