Healthcare Provider Details

I. General information

NPI: 1811731953
Provider Name (Legal Business Name): AMANDA LEIGH BENNER LCPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 STONE ST
AUGUSTA ME
04330-5227
US

IV. Provider business mailing address

66 STONE ST
AUGUSTA ME
04330-5227
US

V. Phone/Fax

Practice location:
  • Phone: 207-855-7635
  • Fax:
Mailing address:
  • Phone: 207-855-7635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC8812
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL7995
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: