Provider Demographics
NPI:1184383903
Name:SLADKY, AMANDA RHEALYNN (MA, P-LPC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RHEALYNN
Last Name:SLADKY
Suffix:
Gender:F
Credentials:MA, P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-9233
Mailing Address - Country:US
Mailing Address - Phone:214-986-5881
Mailing Address - Fax:
Practice Address - Street 1:141 TOWNSHIP AVE STE 303
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8699
Practice Address - Country:US
Practice Address - Phone:601-228-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MSP-0737101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health