MEDICARE: AMANDA EVANOFF

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
1	101Y00000X	Counselor	6401225804	MI

General Provider Information

NPI Number	:	1245845791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA EVANOFF

Provider Business Mailing Address
First Line	:	8949 DIXIE HWY
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348-4246
Country	:	US
Telephone Number	:	810-626-5191
Fax Number	:

Provider Business Practice Location Address
First Line	:	8949 DIXIE HWY
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348-4246
Country	:	US
Telephone Number	:	810-626-5191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	01/28/2026

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Directions to “ AMANDA EVANOFF ” Practice Location

Language	Start Address	Practice Location

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