Individual
AMANDA L LIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LMFT
Contact information
Practice address
360 N CASWELL RD, CHARLOTTE, NC 28204-2442
(704) 421-4887
Mailing address
8041 STONEHAM CT, MATTHEWS, NC 28105-6435
(704) 421-4887
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1139
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6105139
—
NC
Enumeration date
01/09/2007
Last updated
11/27/2012
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