Healthcare Provider Details

I. General information

NPI: 1871410779
Provider Name (Legal Business Name): AMANDA ELIZABETH SHOWALTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 STRAWBERRY PATCH RD
PRINCETON WV
24739-6692
US

IV. Provider business mailing address

222 STRAWBERRY PATCH RD
PRINCETON WV
24739-6692
US

V. Phone/Fax

Practice location:
  • Phone: 304-922-4488
  • Fax:
Mailing address:
  • Phone: 304-922-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCP00944036
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: