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NPI Code Detail

MEDICARE: AMANDA MARTIN LPC

MEDICARE: AMANDA MARTIN LPC
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
1101YP2500XProfessional CounselorLPC008748GA

General Provider Information

NPI Number : 1386181907
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA MARTIN LPC
Provider Business Mailing Address
First Line : 104 PILGRIM VILLAGE DR STE 300
Second Line :
City : CUMMING
State : GA
Zip : 30040-9232
Country : US
Telephone Number : 678-897-3445
Fax Number :
Provider Business Practice Location Address
First Line : 104 PILGRIM VILLAGE DR STE 300
Second Line :
City : CUMMING
State : GA
Zip : 30040-9232
Country : US
Telephone Number : 678-897-3445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2017
Last Update Date : 06/17/2021

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Directions to “ AMANDA MARTIN LPC” Practice Location

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