Provider Demographics
NPI:1104075886
Name:BARNHARDT, AMANDA KATE (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATE
Last Name:BARNHARDT
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 1:5704 MAGELLAN WAY
Mailing Address - Street 2:APARTMENT 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2258
Mailing Address - Country:US
Mailing Address - Phone:336-613-2678
Mailing Address - Fax:
Practice Address - Street 1:5704 MAGELLAN WAY
Practice Address - Street 2:APARTMENT 301
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2258
Practice Address - Country:US
Practice Address - Phone:336-613-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0069401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical