Provider Demographics
NPI:1447647532
Name:AMANDA K. CROWDER, LCSW, PLLC
Entity type:Organization
Organization Name:AMANDA K. CROWDER, LCSW, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CALMING WATERS
Authorized Official - Middle Name:COUNSELING
Authorized Official - Last Name:SERVICES
Authorized Official - Suffix:
Authorized Official - Credentials:MOAC
Authorized Official - Phone:980-299-7436
Mailing Address - Street 1:447 S SHARON AMITY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2836
Mailing Address - Country:US
Mailing Address - Phone:980-299-7436
Mailing Address - Fax:980-226-5507
Practice Address - Street 1:447 S SHARON AMITY RD STE 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2836
Practice Address - Country:US
Practice Address - Phone:980-299-7436
Practice Address - Fax:980-226-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0091101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty