Provider Demographics
NPI:1104466176
Name:GREEN, AMANDA A
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:AINSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2706 PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4314
Mailing Address - Country:US
Mailing Address - Phone:865-297-3391
Mailing Address - Fax:
Practice Address - Street 1:701 N CENTRAL ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-7258
Practice Address - Country:US
Practice Address - Phone:865-297-3391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor