Provider Demographics
NPI:1285275644
Name:ABRAM, AMANDA SODEN
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SODEN
Last Name:ABRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SODEN
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 LEE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-6234
Mailing Address - Country:US
Mailing Address - Phone:318-370-2004
Mailing Address - Fax:318-625-7197
Practice Address - Street 1:1500 LEE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-6234
Practice Address - Country:US
Practice Address - Phone:318-625-7050
Practice Address - Fax:318-625-7197
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator