Basic Information
| Provider Information | |||||||||
| NPI: | 1316302904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DE LA MORA | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PCCI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 490 N GRAPE ST | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609759939 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 490 N GRAPE ST | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609759939 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2015 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPCCI1975 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | APCC9754 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.