| Doctor Name: | MISS AMANDA BLAIR FAULK |
| NPI Number: | 1801134614 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LPCA |
| License Number: | A8888 |
| Business Practice Address: | 110 Sw Center Street Mount Olive, NC - 28365 |
| Business Phone Number: | 9196353344 |
| Business Fax Number: | 9196353388 |
| Mailing Address: | 706 Buckler Ave, ABERDEEN |
| State: | NC |
| Postal Code: | 283153340 |
| Phone Number: | 9107361261 |
| Fax Number: | |
| NPI Enumeration Date: | 01/29/2013 |
| NPI Last Update Date: | 01/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | A8888 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |