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General NPI Number Information
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NPI Number | 1043525041
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Entity Type | Individual
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Provider Name | AMANDA KATHLEEN BRACE LPCC-S, M.ED
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Gender | Female
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 2334 LAKE AVE
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City | ASHTABULA
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State | OH
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Zip | 44004-3440
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Country | US
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Telephone | 440-361-0127
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Fax |
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Provider Business Mailing Address
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Address Line | 2334 LAKE AVE
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City | ASHTABULA
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State | OH
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Zip | 44004-3440
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Country | US
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Telephone | 440-361-0127
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Fax | 330-548-0039
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | OH1485147
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.0900428-SUPV
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License Number State | OH
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