Provider Demographics
NPI:1124483102
Name:BLAIR, AMANDA (EDS, LPC, SPS,NCSP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:EDS, LPC, SPS,NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 ANTOSH CIR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8687
Mailing Address - Country:US
Mailing Address - Phone:870-501-5060
Mailing Address - Fax:870-501-5060
Practice Address - Street 1:2800 BROWNS LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7236
Practice Address - Country:US
Practice Address - Phone:870-501-5060
Practice Address - Fax:870-501-5060
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1602016101YP2500X, 101Y00000X
AR10051133103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool