Healthcare Provider Details

I. General information

NPI: 1922423284
Provider Name (Legal Business Name): AMANDA MARIE SNYDER LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COUNTRY CLUB RD VILLAGE WEST ONE BUILDING 7
GILFORD NH
03249-6972
US

IV. Provider business mailing address

25 COUNTRY CLUB RD VILLAGE WEST ONE BUILDING 7
GILFORD NH
03249-6972
US

V. Phone/Fax

Practice location:
  • Phone: 603-706-0336
  • Fax:
Mailing address:
  • Phone: 603-706-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0865
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: