Provider Demographics
NPI:1154175925
Name:ROBERTSON CELMER, AMANDA (CADCII, CCDS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ROBERTSON CELMER
Suffix:
Gender:F
Credentials:CADCII, CCDS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:CELMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADCII, CCDS
Mailing Address - Street 1:403 SABLE TRACE CV
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-7637
Mailing Address - Country:US
Mailing Address - Phone:770-560-7110
Mailing Address - Fax:
Practice Address - Street 1:270 HERITAGE WALK
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3875
Practice Address - Country:US
Practice Address - Phone:770-560-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01810101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)