Provider Demographics
NPI:1982192639
Name:ARYA, AMANDA CHRISTINE (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:ARYA
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CHRISTINE
Other - Last Name:ENDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2629 PORTLAND ST APT 104B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-4818
Mailing Address - Country:US
Mailing Address - Phone:313-285-0098
Mailing Address - Fax:
Practice Address - Street 1:7505 BLUESTONE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1324
Practice Address - Country:US
Practice Address - Phone:775-464-0929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2025-04-22
Deactivation Date:2023-10-11
Deactivation Code:
Reactivation Date:2023-10-17
Provider Licenses
StateLicense IDTaxonomies
NV11766-C1041C0700X
IC-20311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical