Individual
AMANDA FREDERICK-GALVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17740 PRESTON RD # 100-C, DALLAS, TX 75252-5736
(469) 623-7100
Mailing address
17740 PRESTON RD # 100-C, DALLAS, TX 75252-5736
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
73123
TX
101YA0400X
Addiction (Substance Use Disorder) Counselor
12884
TX
Other
Enumeration date
07/19/2016
Last updated
07/19/2016
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