Healthcare Provider Details

I. General information

NPI: 1730699059
Provider Name (Legal Business Name): AMANDA LOUELLEN DRIGGERS LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 WILDWOOD AVE APT 3
ASHEVILLE NC
28804-3555
US

IV. Provider business mailing address

31 WILDWOOD AVE APT 3
ASHEVILLE NC
28804-3555
US

V. Phone/Fax

Practice location:
  • Phone: 910-840-1051
  • Fax:
Mailing address:
  • Phone: 910-840-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number12055A
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number12055A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: