Provider Demographics
NPI:1548653439
Name:RONNE, AMANDA KATHLEEN (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATHLEEN
Last Name:RONNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6816
Mailing Address - Country:US
Mailing Address - Phone:910-790-9949
Mailing Address - Fax:910-202-9966
Practice Address - Street 1:4005 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6816
Practice Address - Country:US
Practice Address - Phone:910-790-9949
Practice Address - Fax:910-202-9966
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0102331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical