Provider Demographics
NPI:1861178048
Name:BOES, AMANDA MARIE WEICHERT (LMSW-CLINICAL)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE WEICHERT
Last Name:BOES
Suffix:
Gender:F
Credentials:LMSW-CLINICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 PINE HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1878
Mailing Address - Country:US
Mailing Address - Phone:248-990-6865
Mailing Address - Fax:
Practice Address - Street 1:1200 ROBERT T LONGWAY BLVD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503
Practice Address - Country:US
Practice Address - Phone:810-339-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011166461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical