MEDICARE: AMANDA PRIMROSE 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
1	101YM0800X	Mental Health Counselor	LPC016061	GA
2	101YM0800X	Mental Health Counselor	PC009459	PA

General Provider Information

NPI Number	:	1841138401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA PRIMROSE LPC

Provider Business Mailing Address
First Line	:	934 BRIARCLIFF RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-2618
Country	:	US
Telephone Number	:	404-888-6024
Fax Number	:	404-888-7330

Provider Business Practice Location Address
First Line	:	934 BRIARCLIFF RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-2618
Country	:	US
Telephone Number	:	404-888-6024
Fax Number	:	404-888-7330

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

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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