=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447647532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMANDA K. CROWDER, LCSW, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2015
-----------------------------------------------------
Last Update Date | 07/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 447 S SHARON AMITY RD STE 105
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28211-2836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-299-7436
-----------------------------------------------------
Fax | 980-226-5507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 447 S SHARON AMITY RD STE 105
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28211-2836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-299-7436
-----------------------------------------------------
Fax | 980-226-5507
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MRS. CALMING WATERS COUNSELING SERVICES
-----------------------------------------------------
Credential | MOAC
-----------------------------------------------------
Telephone | 980-299-7436
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C009110
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------