Individual
AMANDA LEE CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3621 W ASH AVE, FULLERTON, CA 92833-3107
(714) 872-0034
(213) 935-8728
Mailing address
3621 W ASH AVE, FULLERTON, CA 92833-3107
(714) 872-0034
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
ASW36736
CA
1041C0700X
Clinical Social Worker
Primary
LCSW82461
CA
Other
Enumeration date
09/19/2012
Last updated
11/29/2019
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