Healthcare Provider Details

I. General information

NPI: 1528798808
Provider Name (Legal Business Name): AMANDA RAE SMITH M.A., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 EASTERN PKWY STE 3328
LOUISVILLE KY
40217-1415
US

IV. Provider business mailing address

2221 GARY DR
NEW ALBANY IN
47150-4629
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number277707
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: