Individual
AMANDA LOIS CREEL BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
517 ENERGY CENTER BLVD STE 1302, NORTHPORT, AL 35473-5810
(205) 553-9171
(334) 218-5815
Mailing address
517 ENERGY CENTER BLVD STE 1302, NORTHPORT, AL 35473-5810
(205) 532-7387
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5110C-S
AL
Other
Enumeration date
02/19/2024
Last updated
03/11/2024
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