Provider Demographics
NPI:1720730971
Name:FORD, AMANDA JEAN PERPICH (LCSW, LMSW, MSW MACJ)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JEAN PERPICH
Last Name:FORD
Suffix:
Gender:F
Credentials:LCSW, LMSW, MSW MACJ
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:PERPICH BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LMSW, MSW MACJ
Mailing Address - Street 1:103 CONTINENTAL PL STE 204
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1042
Mailing Address - Country:US
Mailing Address - Phone:602-717-7316
Mailing Address - Fax:
Practice Address - Street 1:103 CONTINENTAL PL STE 204
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1042
Practice Address - Country:US
Practice Address - Phone:602-717-7316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-432391041C0700X
TN88141041C0700X
ORL110641041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical