MEDICARE: AMANDA LASHAUN WESLEY LPCA

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	106S00000X	Behavior Technician	RBT-21-185844	GA
2	101YM0800X	Mental Health Counselor	10429	SC

General Provider Information

NPI Number	:	1457022295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LASHAUN WESLEY LPCA

Provider Business Mailing Address
First Line	:	103 OAK COVE DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7513
Country	:	US
Telephone Number	:	912-581-5695
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 OAK COVE DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7513
Country	:	US
Telephone Number	:	912-581-5695
Fax Number	:

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

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	12/08/2025

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