Provider Demographics
NPI:1285835124
Name:PHILLIPS, AMANDA M (LICSW)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VESTAVIA PKWY STE 406
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3763
Mailing Address - Country:US
Mailing Address - Phone:205-778-8300
Mailing Address - Fax:659-208-2752
Practice Address - Street 1:209 PARK FOREST TER
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-7703
Practice Address - Country:US
Practice Address - Phone:205-447-9402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3645C1041C0700X
101Y00000X
IA1197431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor