Healthcare Provider Details

I. General information

NPI: 1710386792
Provider Name (Legal Business Name): AMANDA STOLZ COMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA GORDON

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10990 BELTON HONEA PATH HWY
HONEA PATH SC
29654-9506
US

IV. Provider business mailing address

9 SHADETREE CT
GREER SC
29651-6864
US

V. Phone/Fax

Practice location:
  • Phone: 305-332-5011
  • Fax:
Mailing address:
  • Phone: 305-332-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number6160
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number6160
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: