=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578817151
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA EARNHARDT LPCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2012
-----------------------------------------------------
Last Update Date | 11/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 417 N MAIN ST
-----------------------------------------------------
City | CHINA GROVE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28023-2533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-855-3276
-----------------------------------------------------
Fax | 704-855-0823
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 402 LOUISE AVE
-----------------------------------------------------
City | CHINA GROVE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28023-2020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-855-3276
-----------------------------------------------------
Fax | 704-855-0823
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | A9786
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------