Provider Demographics
NPI:1730870551
Name:BERNARD, AMANDA LEANN
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEANN
Last Name:BERNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 13TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4801
Mailing Address - Country:US
Mailing Address - Phone:828-238-3748
Mailing Address - Fax:
Practice Address - Street 1:1899 TATE BLVD SE # 2106
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4200
Practice Address - Country:US
Practice Address - Phone:828-358-0976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician