Individual
AMANDA ELIZABETH GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
224 NORTH MAIN STREET, JEFFERSON, NC 28640
(336) 846-7492
(336) 846-7397
Mailing address
PO BOX 212, JEFFERSON, NC 28640-0212
(336) 846-7492
(336) 846-7397
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3369
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1226J
BLUECROSS AND BLUESHIELD
NC
05
—
6102328
—
NC
Enumeration date
04/09/2007
Last updated
07/08/2007
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