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General NPI Number Information
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NPI Number | 1558938225
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Entity Type | Individual
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Provider Name | AMANDA MARYNNE RODOLA M.A.
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Gender | Female
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 504 W VISTA WAY
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City | VISTA
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State | CA
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Zip | 92083-5704
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Country | US
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Telephone | 760-940-1836
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Fax |
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Provider Business Mailing Address
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Address Line | 1660 HOTEL CIR N STE AND314
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City | SAN DIEGO
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State | CA
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Zip | 92108-2807
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Country | US
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Telephone | 619-961-2120
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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 | 94027351
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSB94027351
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 101YA0400X
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License Number State | CA
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