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General NPI Number Information
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NPI Number | 1821414103
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Entity Type | Individual
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Provider Name | AMANDA DEVOLLD MED, LPCC-S, LCDCIII
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Gender | Female
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 1225 WOODLAWN AVE
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City | CAMBRIDGE
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State | OH
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Zip | 43725-3094
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Country | US
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Telephone | 855-692-7247
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Fax |
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Provider Business Mailing Address
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Address Line | 1495 SUNFLOWER RD
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City | NEW CONCORD
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State | OH
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Zip | 43762-9671
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Country | US
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Telephone | 614-394-6047
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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 | LCDC.121001-3
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E.1000376-SUPV
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License Number State | OH
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