Provider Demographics
NPI:1104148436
Name:CHARLTON-FRYER, AMANDA SUE (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:SUE
Last Name:CHARLTON-FRYER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:SUE
Other - Last Name:CHARLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MED CENTER DR
Mailing Address - Street 2:LOUIS A. JOHNSON VA MEDICAL CENTER MENTAL HEALTH CLINIC
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4155
Mailing Address - Country:US
Mailing Address - Phone:304-623-3461
Mailing Address - Fax:
Practice Address - Street 1:1 MED CENTER DR
Practice Address - Street 2:LOUIS A. JOHNSON VA MEDICAL CENTER MENTAL HEALTH CLINIC
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4155
Practice Address - Country:US
Practice Address - Phone:304-623-3461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016963103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist