Provider Demographics
NPI:1942667266
Name:STYRON, AMANDA CHRISTINE (LPCA, NCC, CCMHCE)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:STYRON
Suffix:
Gender:F
Credentials:LPCA, NCC, CCMHCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 N PIGOTT RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28528-9306
Mailing Address - Country:US
Mailing Address - Phone:252-342-3393
Mailing Address - Fax:
Practice Address - Street 1:3332 BRIDGES ST STE A
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3296
Practice Address - Country:US
Practice Address - Phone:252-726-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-17
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12138101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional