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General NPI Number Information
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NPI Number | 1407577968
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Entity Type | Individual
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Provider Name | AMANDA R BRETTILLO
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Gender | Female
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 76 JOHNNY MARLOW RD
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City | FAIRVIEW
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State | NC
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Zip | 28730-9641
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Country | US
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Telephone | 828-551-7571
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Fax |
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Provider Business Mailing Address
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Address Line | 76 JOHNNY MARLOW RD
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City | FAIRVIEW
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State | NC
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Zip | 28730-9641
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Country | US
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Telephone | 828-551-7571
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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 | LCAS-30634
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 2022-9757-01
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P021851
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License Number State | NC
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