Individual
AMANDA SUPERVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
455 SWIFTSIDE DR, SUITE 102, CARY, NC 27518-7200
(919) 271-8579
Mailing address
2536 URBINO CT, APEX, NC 27502-4730
(919) 271-8579
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C005337
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6106418
—
NC
Enumeration date
11/29/2006
Last updated
08/01/2023
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