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General NPI Number Information
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NPI Number | 1063914869
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Entity Type | Individual
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Provider Name | AMANDA FORISTER MS
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Gender | Female
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 200 E GRANADA BLVD STE D
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City | ORMOND BEACH
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State | FL
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Zip | 32176-6694
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Country | US
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Telephone | 307-257-2331
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Fax | 307-670-8042
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Provider Business Mailing Address
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Address Line | 319 OAK FERN CIR
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City | ORMOND BEACH
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State | FL
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Zip | 32174-4875
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Country | US
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Telephone | 307-363-2250
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PPC-1056
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC1828
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | MH24302
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH24302
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License Number State | FL
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