Individual
AMANDA PHITSAMAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 W BRIGGSMORE AVE STE I, MODESTO, CA 95350-3839
(209) 526-1476
(209) 526-0908
Mailing address
2000 W BRIGGSMORE AVE STE I, MODESTO, CA 95350-3839
(209) 526-1476
(209) 526-0908
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
ASW110192
CA
Other
Enumeration date
06/01/2022
Last updated
09/15/2022
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