Healthcare Provider Details

I. General information

NPI: 1346447802
Provider Name (Legal Business Name): AMANDA BROOKE SLAUGHTER ED.D, LPC RPT-S CPCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 HUTCHINSON RD STE 102
CUMMING GA
30040-0500
US

IV. Provider business mailing address

3615 HUTCHINSON RD STE 102
CUMMING GA
30040-0500
US

V. Phone/Fax

Practice location:
  • Phone: 888-850-4891
  • Fax: 888-959-0350
Mailing address:
  • Phone: 888-850-4891
  • Fax: 888-959-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004935
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: