Provider Demographics
NPI:1447880315
Name:RUKAVINA, AMANDA KAYE (LMHCA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAYE
Last Name:RUKAVINA
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1963 SAINT ST # 75
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2101
Mailing Address - Country:US
Mailing Address - Phone:509-980-2614
Mailing Address - Fax:
Practice Address - Street 1:1963 SAINT ST # 75
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2101
Practice Address - Country:US
Practice Address - Phone:509-980-2614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WA61262226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health