Doctor Name: | MRS. AMANDA LYNN SHORES |
NPI Number: | 1154735025 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS-ADP |
License Number: | |
Business Practice Address: | 975 Solomons Island Rd N Prince Frederick, MD - 206783917 |
Business Phone Number: | 4105353079 |
Business Fax Number: | 4105352220 |
Mailing Address: | Po Box 1158, PRINCE FREDERICK |
State: | MD |
Postal Code: | 206781158 |
Phone Number: | 4105353079 |
Fax Number: | 4105352220 |
NPI Enumeration Date: | 06/18/2014 |
NPI Last Update Date: | 06/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |