Healthcare Provider Details

I. General information

NPI: 1427300409
Provider Name (Legal Business Name): AMANDA LACKEY MS,RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5767 COVE COMMONS DR SE
BROWNSBORO AL
35741-9744
US

IV. Provider business mailing address

5767 COVE COMMONS DR SE STE 5
BROWNSBORO AL
35741-9744
US

V. Phone/Fax

Practice location:
  • Phone: 866-522-2467
  • Fax:
Mailing address:
  • Phone: 866-542-2467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: