Individual
MS. AMANDA LORRAINE DAVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHS
Contact information
Practice address
188 W HEBBLE AVE, FAIRBORN, OH 45324-4960
(937) 206-3219
Mailing address
PO BOX 396, SPRINGBORO, OH 45066-0396
(937) 301-9578
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2846826
—
OH
Enumeration date
04/24/2018
Last updated
06/29/2022
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