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General NPI Number Information
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NPI Number | 1699598409
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Entity Type | Individual
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Provider Name | AMANDA WALSTEDT LPC, LCADC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 80 MAIN ST STE 500
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City | WEST ORANGE
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State | NJ
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Zip | 07052-5414
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Country | US
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Telephone | 973-964-5769
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Fax |
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Provider Business Mailing Address
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Address Line | 97 BLEECKER ST APT 11
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City | JERSEY CITY
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State | NJ
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Zip | 07307-3400
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Country | US
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Telephone |
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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 | 37LC00381100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00987400
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License Number State | NJ
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