Provider Demographics
NPI:1962086744
Name:POWELL, AMANDA SHEREE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SHEREE
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:IL
Mailing Address - Zip Code:61474
Mailing Address - Country:US
Mailing Address - Phone:309-333-0293
Mailing Address - Fax:
Practice Address - Street 1:34 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:IL
Practice Address - Zip Code:61474-9800
Practice Address - Country:US
Practice Address - Phone:309-351-8584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-08
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0230381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical