Basic Information
| Provider Information | |||||||||
| NPI: | 1053906800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLANAGAN | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | T-CDAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3036 VEAZEY AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452383507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133906225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1974 WALTON NICHOLSON PIKE | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410517906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008056989 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2021 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.