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NPI Code Detail

MEDICARE: MRS. AMANDA L MILLER-HODGES LMHC, C-DBT

MEDICARE: MRS. AMANDA L MILLER-HODGES LMHC, C-DBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
2101YM0800XMental Health CounselorMH20864FL

General Provider Information

NPI Number : 1073852828
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA L MILLER-HODGES LMHC, C-DBT
Provider Business Mailing Address
First Line : 1903 ISLAND WALK WAY
Second Line :
City : FERNANDINA BEACH
State : FL
Zip : 32034-4797
Country : US
Telephone Number : 904-277-0027
Fax Number : 407-867-6261
Provider Business Practice Location Address
First Line : 1903 ISLAND WALK WAY
Second Line :
City : FERNANDINA BEACH
State : FL
Zip : 32034-4797
Country : US
Telephone Number : 904-277-0027
Fax Number : 407-867-6261
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2013
Last Update Date : 02/17/2023

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