Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH12110 | FL |
NPI | 1003244484 |
---|---|
Provider Name | Mrs. Amanda Sweat |
First Address | Jacksonville, FL 32222-2858 |
Second Address | Jacksonville, FL 32222-2858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2013 |
Last Update Date | 29/11/2021 |