Healthcare Provider Details

I. General information

NPI: 1063976785
Provider Name (Legal Business Name): AMANDA CHRISTINE DUECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2019
Last Update Date: 01/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E TUNNELL ST
SANTA MARIA CA
93454-4146
US

IV. Provider business mailing address

1240 BETHEL LN APT 30F
SANTA MARIA CA
93458-6313
US

V. Phone/Fax

Practice location:
  • Phone: 805-925-0315
  • Fax:
Mailing address:
  • Phone: 805-406-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: