Individual
AMANDA R BRETTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
76 JOHNNY MARLOW RD, FAIRVIEW, NC 28730-9641
(828) 551-7571
Mailing address
76 JOHNNY MARLOW RD, FAIRVIEW, NC 28730-9641
(828) 551-7571
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-30634
NC
1041C0700X
Clinical Social Worker
Primary
P021851
NC
175T00000X
Peer Specialist
2022-9757-01
NC
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2022-9757-01
NC DIVISON OF MENTAL HEALTH,DEVELOPMETAL DISABILITIES AND SUBSTANCE ABUSE
NC
05
—
40422193
—
NC
01
—
M2024-9757-01
NORTH CAROLINA PEER SUPPORT SPECIALIST
NC
01
—
P021851
LCSWA LICENSE
NC
Enumeration date
09/02/2022
Last updated
04/08/2025
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