Provider Demographics
NPI:1982048179
Name:DAVIS, AMANDA MM (LPC-S)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MM
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:VARGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3157 OGDEN HWY
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-9204
Mailing Address - Country:US
Mailing Address - Phone:419-290-8884
Mailing Address - Fax:
Practice Address - Street 1:3157 OGDEN HWY
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-9204
Practice Address - Country:US
Practice Address - Phone:419-290-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional