Provider Demographics
NPI:1699555961
Name:HIPPERT-CAMP, AMANDA K (BA, CADC-I)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:HIPPERT-CAMP
Suffix:
Gender:F
Credentials:BA, CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 RUSTY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9389
Mailing Address - Country:US
Mailing Address - Phone:702-918-8398
Mailing Address - Fax:
Practice Address - Street 1:1200 HARRIS SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89124-9215
Practice Address - Country:US
Practice Address - Phone:702-872-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2024-09-12
Deactivation Date:2024-08-16
Deactivation Code:
Reactivation Date:2024-09-10
Provider Licenses
StateLicense IDTaxonomies
NV07824-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)