Provider Demographics
NPI:1093843260
Name:WHITLEY, AMANDA BETH THOMAS (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETH THOMAS
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 EDWARD CURD LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5662
Mailing Address - Country:US
Mailing Address - Phone:615-599-7680
Mailing Address - Fax:615-599-3780
Practice Address - Street 1:2105 EDWARD CURD LN
Practice Address - Street 2:SUITE 103
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5662
Practice Address - Country:US
Practice Address - Phone:615-599-7680
Practice Address - Fax:615-599-3780
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical