| Amanda Blackwell, Pllc | |
|
6255 Towncenter Dr Ste 893 Clemmons NC 27012-9376 | |
| (336) 794-6734 | |
| (336) 792-2671 |
| Full Name | Amanda Blackwell, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 6255 Towncenter Dr Ste 893, Clemmons, North Carolina |
| Authorized Official Name and Position | Frances Amanda Blackwell (OWNER) |
| Authorized Official Contact | 9192743856 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amanda Blackwell, Pllc 815 Madison Ave Winston Salem NC 27103-3746 Ph: (919) 274-3856 | Amanda Blackwell, Pllc 6255 Towncenter Dr Ste 893 Clemmons NC 27012-9376 Ph: (336) 794-6734 |
| NPI Number | 1235881004 |
|---|---|
| Provider Enumeration Date | 01/24/2022 |
| Last Update Date | 04/18/2024 |
| Certification Date | 04/18/2024 |
| Medicare PECOS PAC ID | 8224423546 |
|---|---|
| Medicare Enrollment ID | O20220322003166 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235881004 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Frances Amanda Blackwell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578005245 PECOS PAC ID: 1951796275 Enrollment ID: I20220429000211 |
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