Provider Demographics
NPI:1194439703
Name:DANIELS, AMANDA (LSWAIC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:HIGHTOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15998 BETHEL BURLEY RD SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-8249
Mailing Address - Country:US
Mailing Address - Phone:360-474-3420
Mailing Address - Fax:
Practice Address - Street 1:15998 BETHEL BURLEY RD SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-8249
Practice Address - Country:US
Practice Address - Phone:360-474-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC611408931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical