Provider Demographics
NPI:1285766931
Name:BOLES, AMANDA PAIGE (CMSW)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:PAIGE
Last Name:BOLES
Suffix:
Gender:F
Credentials:CMSW
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:PAIGE
Other - Last Name:LACHOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:296 EARL SLATE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5601
Mailing Address - Country:US
Mailing Address - Phone:615-218-7847
Mailing Address - Fax:931-503-4620
Practice Address - Street 1:901 MARTIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-4090
Practice Address - Country:US
Practice Address - Phone:931-503-4600
Practice Address - Fax:931-503-4620
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker