Provider Demographics
NPI:1215313879
Name:THOMAS, AMANDA JO (LCMHC, LPC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JO
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N HORNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-3939
Mailing Address - Country:US
Mailing Address - Phone:919-897-5111
Mailing Address - Fax:888-972-8390
Practice Address - Street 1:304 N HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-3939
Practice Address - Country:US
Practice Address - Phone:919-897-5111
Practice Address - Fax:888-972-8390
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12380101YM0800X
TN5451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health