Provider Demographics
NPI:1376398438
Name:MCGILL, AMANDA RIVENBARK (MA, LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RIVENBARK
Last Name:MCGILL
Suffix:
Gender:F
Credentials:MA, LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WIND CHIME CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6460
Mailing Address - Country:US
Mailing Address - Phone:919-916-5006
Mailing Address - Fax:
Practice Address - Street 1:105 WIND CHIME CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6460
Practice Address - Country:US
Practice Address - Phone:919-916-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19918101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional