Amanda R Brettillo
Individual provider Active NPI Clinical Social Worker · Fairview, NC
NPI 1407577968 · NPPES record last updated Apr 8, 2025
Key facts
- NPI
- 1407577968
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- P021851 (NC)
- Practice address
- 76 Johnny Marlow Rd
Fairview, NC 28730-9641 - Phone
- (828) 551-7571
- NPI assigned
- Sep 2, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCAS-30634 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| P021851 | NC | MD | Clinical Social Worker |
| 2022-9757-01 | NC | MD | Peer Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inspiration Bridgeway LLC | Addiction (Substance Use Disorder) | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | LCAS-30634 | NC | |
| Peer Specialist |
175T00000X | 2022-9757-01 | NC | |
| Private Vehicle | 347C00000X | |||
| Clinical Social Worker |
1041C0700X | P021851 | NC | Yes |
Addresses
Primary practice location
76 Johnny Marlow Rd
Fairview, NC 28730-9641
Mailing address
76 Johnny Marlow Rd
Fairview, NC 28730-9641
Phone (828) 551-7571
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M2024-9757-01 | Other | NC | NORTH CAROLINA PEER SUPPORT SPECIALIST |
| P021851 | Other | NC | LCSWA LICENSE |
| 40422193 | Medicaid | NC | |
| 2022-9757-01 | Other | NC | NC DIVISON OF MENTAL HEALTH,DEVELOPMETAL DISABILITIES AND SUBSTANCE ABUSE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | amandadaniels@inspirationbridgeway.com | Health Information Exchange (HIE) |
Other providers in Fairview, NC
- Austin Avrett
- Bckingsbury PLLC
- Beckys Rest Home 11
- Sara Beth Bensman
- Rebecca Sue Bonfey
- Sandi Irene Bryant
- Robert Timothy Busey
- Carolina Mountain Medical Supplies
- Marian Elizabeth Catlin
- Certain Seasons Mental Health Therapy PLLC
All providers in Fairview, NC · Clinical Social Worker in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.