Provider Demographics
NPI:1124336300
Name:PACK, AMANDA COOK (MS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:COOK
Last Name:PACK
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 EXECUTIVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6062
Mailing Address - Country:US
Mailing Address - Phone:334-332-9077
Mailing Address - Fax:334-363-0740
Practice Address - Street 1:2206 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6062
Practice Address - Country:US
Practice Address - Phone:334-332-9077
Practice Address - Fax:334-363-0740
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst