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Individual

MRS. AMANDA LYNN OVERACRE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
730 N COLLEGE RD STE A-B, TWIN FALLS, ID 83301-3416
(208) 814-8000
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
104100000X
Social Worker
002441
CT
1041C0700X
Clinical Social Worker
C013833
NC
1041C0700X
Clinical Social Worker
Primary
LCSW-42059
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
42059
LCSW
ID
01
C013833
LCSW
NC
01
P014431
LCSW-A
NC
Enumeration date
07/17/2012
Last updated
06/06/2024
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