Provider Demographics
NPI:1205719598
Name:HOLLIS, AMANDA LOUISE (LICSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOUISE
Last Name:HOLLIS
Suffix:
Gender:X
Credentials:LICSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LOUISE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:111 LEE ROAD 802 UNIT 125
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-6657
Mailing Address - Country:US
Mailing Address - Phone:334-750-3754
Mailing Address - Fax:
Practice Address - Street 1:111 LEE ROAD 802 UNIT 125
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-6657
Practice Address - Country:US
Practice Address - Phone:334-750-3754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6382C101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional