Individual
AMANDA MARIE BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LCAC
Contact information
Practice address
2530 SANDCREST BLVD, COLUMBUS, IN 47203-3047
(812) 372-3177
(812) 372-3692
Mailing address
2530 SANDCREST BLVD, COLUMBUS, IN 47203-3047
(812) 372-3177
(812) 372-3692
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001472A
IN
1041C0700X
Clinical Social Worker
Primary
34006170A
IN
Other
Enumeration date
05/21/2007
Last updated
04/15/2013
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