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General NPI Number Information
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NPI Number | 1437566031
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Entity Type | Individual
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Provider Name | AMANDA PRENTICE MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | 363 CHURCH ST N SUITE 200
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City | CONCORD
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State | NC
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Zip | 28025-4589
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Country | US
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Telephone | 704-262-1348
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Fax |
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Provider Business Mailing Address
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Address Line | 109 PENNY ST
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City | ALBEMARLE
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State | NC
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Zip | 28001-2803
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Country | US
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Telephone | 704-985-1178
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P007219
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C009261
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License Number State | NC
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