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General NPI Number Information
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NPI Number | 1053906800
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Entity Type | Individual
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Provider Name | AMANDA LEE FLANAGAN T-CDAC
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Gender | Female
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 1974 WALTON NICHOLSON PIKE
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City | INDEPENDENCE
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State | KY
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Zip | 41051-7906
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Country | US
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Telephone | 800-805-6989
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Fax |
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Provider Business Mailing Address
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Address Line | 3036 VEAZEY AVE
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City | CINCINNATI
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State | OH
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Zip | 45238-3507
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Country | US
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Telephone | 513-390-6225
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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