Provider Demographics
NPI:1548503287
Name:HIEMENZ, AMANDA YVONNE (MA, NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:YVONNE
Last Name:HIEMENZ
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WENDOVER LANE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5578
Mailing Address - Country:US
Mailing Address - Phone:919-886-8783
Mailing Address - Fax:
Practice Address - Street 1:1415 W NC HIGHWAY 54 STE 123
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5578
Practice Address - Country:US
Practice Address - Phone:919-808-2010
Practice Address - Fax:919-502-7474
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10026101YM0800X
NC10026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health