Individual
AMANDA TADLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S., M.A.
Contact information
Practice address
3965 FISH HATCHERY RD, GASTON, SC 29053-9038
(803) 755-2261
Mailing address
301 PALMETTO PARK BLVD, LEXINGTON, SC 29072-7872
(803) 996-1500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701005494
VA
Other
Enumeration date
11/25/2013
Last updated
11/25/2013
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