Healthcare Provider Details

I. General information

NPI: 1205409380
Provider Name (Legal Business Name): AMANDA K ROSS LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 ARLINGTON AVE
FAYETTEVILLE NC
28303-5403
US

IV. Provider business mailing address

2570 N SHANNON RD
SHANNON NC
28386-9259
US

V. Phone/Fax

Practice location:
  • Phone: 910-461-9291
  • Fax: 910-676-8009
Mailing address:
  • Phone: 860-335-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP016400
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: