Provider Demographics
NPI:1063059624
Name:AMWAY, ASIA (LACMH)
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:
Last Name:AMWAY
Suffix:
Gender:
Credentials:LACMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W 34TH ST APT N9
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2536
Mailing Address - Country:US
Mailing Address - Phone:717-602-5577
Mailing Address - Fax:
Practice Address - Street 1:505 MAIN ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:DE
Practice Address - Zip Code:19730-2013
Practice Address - Country:US
Practice Address - Phone:302-279-6491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEAC-0010472101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health