Healthcare Provider Details

I. General information

NPI: 1003125451
Provider Name (Legal Business Name): AMANDA GARRISON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9445 FARNHAM ST SUITE100
SAN DIEGO CA
92123
US

IV. Provider business mailing address

9445 FARNHAM ST SUITE100
SAN DIEGO CA
92123-1308
US

V. Phone/Fax

Practice location:
  • Phone: 858-380-4676
  • Fax:
Mailing address:
  • Phone: 858-380-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF83662
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC5006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: