Individual
AMANDA M WATTENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT-S
Contact information
Practice address
195 N GRANT AVE STE 250, COLUMBUS, OH 43215-2855
(888) 522-9174
(614) 928-9092
Mailing address
202 E BAGLEY RD, BEREA, OH 44017-2058
(440) 260-8300
(440) 260-8305
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ICDC.161006
OH
101YP2500X
Professional Counselor
M0900021
OK
106H00000X
Marriage & Family Therapist
Primary
F1300004-SUPV
OH
Other
Enumeration date
09/11/2012
Last updated
04/22/2016
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