Individual
MRS. AMANDA RENEE SOUTHERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
275 S STATE RD, OTISVILLE, MI 48463-8436
(810) 922-7700
Mailing address
275 S STATE RD, OTISVILLE, MI 48463-8436
(810) 922-7700
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801094249
MI
Other
Enumeration date
03/07/2013
Last updated
05/17/2022
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