Healthcare Provider Details

I. General information

NPI: 1619263043
Provider Name (Legal Business Name): AMANDA LYNN DYE MA,LPC,CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2091 PROFESSIONAL DR
FLINT MI
48532-3657
US

IV. Provider business mailing address

7145 BIRCHWOOD DR
MOUNT MORRIS MI
48458-8977
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-1652
  • Fax: 810-732-1735
Mailing address:
  • Phone: 810-610-2632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6401009783
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: