Provider Demographics
NPI:1962777870
Name:SHUB, AMANDA N (LPC, NCC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:SHUB
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-0250
Mailing Address - Country:US
Mailing Address - Phone:770-842-4420
Mailing Address - Fax:770-667-3879
Practice Address - Street 1:5755 NORTHPOINT PKWY
Practice Address - Street 2:SUITE # 256
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1142
Practice Address - Country:US
Practice Address - Phone:770-667-3877
Practice Address - Fax:770-667-3879
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional