Individual
AMANDA LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 CALIFORNIA ST, EUREKA, CA 95501-1621
(707) 443-8322
(707) 445-1445
Mailing address
4906 VALLEY EAST BLVD, APT. H, ARCATA, CA 95521-4680
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/23/2007
Last updated
07/08/2007
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