Provider Demographics
NPI:1962984666
Name:ALEXANDER, AMANDA BETH
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETH
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 KIM MILLER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE TOXAWAY
Mailing Address - State:NC
Mailing Address - Zip Code:28747-6777
Mailing Address - Country:US
Mailing Address - Phone:843-475-0089
Mailing Address - Fax:
Practice Address - Street 1:2601 KIM MILLER RD
Practice Address - Street 2:
Practice Address - City:LAKE TOXAWAY
Practice Address - State:NC
Practice Address - Zip Code:28747-6777
Practice Address - Country:US
Practice Address - Phone:843-475-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106S00000X
SC1-20-46337103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician