Provider Demographics
NPI:1366990384
Name:JONES, AMANDA MARIE (PHD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 WILD LILAC
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2431
Mailing Address - Country:US
Mailing Address - Phone:410-689-9075
Mailing Address - Fax:
Practice Address - Street 1:6851 OAK HALL LN STE 118
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5815
Practice Address - Country:US
Practice Address - Phone:410-689-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0212103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical