Individual
AMANDA RAE VANTILBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
878 ALTAMONT RIDGE DR, COLORADO SPRINGS, CO 80921-8414
(254) 394-4908
Mailing address
878 ALTAMONT RIDGE DR, COLORADO SPRINGS, CO 80921-8414
(254) 394-4908
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-4518
HI
Other
Enumeration date
03/06/2021
Last updated
05/07/2022
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