Provider Demographics
NPI:1396347639
Name:ADAMS, AMANDA ELYSE (PPS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELYSE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 CONSTELLATION RD
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-1099
Mailing Address - Country:US
Mailing Address - Phone:805-742-2895
Mailing Address - Fax:
Practice Address - Street 1:4350 CONSTELLATION RD
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-1099
Practice Address - Country:US
Practice Address - Phone:805-742-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool