Provider Demographics
NPI:1316383896
Name:MARKLE, AMANDA BETH (CADC, CSW)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BETH
Last Name:MARKLE
Suffix:
Gender:F
Credentials:CADC, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 DUPONT CIR STE 226
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4847
Mailing Address - Country:US
Mailing Address - Phone:502-896-8006
Mailing Address - Fax:502-896-8055
Practice Address - Street 1:4010 DUPONT CIR STE 226
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4847
Practice Address - Country:US
Practice Address - Phone:502-896-8006
Practice Address - Fax:502-896-8055
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01175101YA0400X
KY255156104100000X
KY118338101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker