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General NPI Number Information
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NPI Number | 1992473383
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Entity Type | Individual
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Provider Name | AMANDA DAFFRON MAED
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Gender | Female
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 1700 CARGO CT
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City | LOUISVILLE
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State | KY
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Zip | 40299-1938
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Country | US
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Telephone | 800-805-6989
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Fax |
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Provider Business Mailing Address
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Address Line | 2829 S 3RD ST APT 1
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City | LOUISVILLE
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State | KY
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Zip | 40208-1453
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Country | US
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Telephone | 314-456-5635
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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 |
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License Number State |
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