Individual
MRS. AMANDA RAE LIGHTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1541 ANNEX RD, JEFFERSON, WI 53549-9803
(920) 674-8197
(920) 674-6113
Mailing address
1541 ANNEX RD, JEFFERSON, WI 53549-9803
(920) 674-8197
(920) 674-6113
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17267-130
WI
101YM0800X
Mental Health Counselor
Primary
5961125
WI
Other
Enumeration date
11/08/2013
Last updated
09/19/2016
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