Provider Demographics
NPI:1174654644
Name:MATTHEWS-HARGRAVE, AMANDA (LMHC, LCAC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:MATTHEWS-HARGRAVE
Suffix:
Gender:F
Credentials:LMHC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-1503
Mailing Address - Country:US
Mailing Address - Phone:812-905-0182
Mailing Address - Fax:812-268-6767
Practice Address - Street 1:1 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-1503
Practice Address - Country:US
Practice Address - Phone:812-905-0182
Practice Address - Fax:812-268-6767
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001130A101YA0400X
IN39001856A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)