Healthcare Provider Details

I. General information

NPI: 1013699412
Provider Name (Legal Business Name): AMANDA MARIE GALLOWAY LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 HOSPITAL LOOP
BERLIN VT
05602-9523
US

IV. Provider business mailing address

PO BOX 647
MONTPELIER VT
05601-0647
US

V. Phone/Fax

Practice location:
  • Phone: 802-229-0591
  • Fax: 802-223-3667
Mailing address:
  • Phone: 802-229-0591
  • Fax: 802-223-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0135371
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: