Healthcare Provider Details

I. General information

NPI: 1922384197
Provider Name (Legal Business Name): AMANDA CHRISTINE JOYCE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 14TH AVE.
LONGVIEW WA
98632
US

IV. Provider business mailing address

921 14TH AVE
LONGVIEW WA
98632
US

V. Phone/Fax

Practice location:
  • Phone: 360-423-0203
  • Fax: 360-423-5086
Mailing address:
  • Phone: 360-423-0203
  • Fax: 360-577-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60707126
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: