Amanda Danielle Main, RADT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1425370421 Issued in CA

Practice address

2220 Girard St
San Jacinto, CA 92583-5301

Phone

(951) 925-8450

NPI assigned

Apr 20, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mfi Recovery Center

  • Substance Abuse Rehabilitation Facility
  • Banning, CA
  • NPI 1164194080
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1861073884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2220 GIRARD ST",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835301",
            "telephone_number": "951-925-8450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 GIRARD ST",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835301",
            "telephone_number": "951-925-8450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "43250 Midnight Ct",
            "address_purpose": "LOCATION",
            "city": "Banning",
            "state": "CA",
            "postal_code": "922209565",
            "country_code": "US",
            "telephone_number": "951-922-1725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAIN",
        "first_name": "AMANDA",
        "middle_name": "DANIELLE",
        "credential": "RADT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-20",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1425370421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Jade Lussenheide
• Corey Macedon
• Albert Macias Jr., DDS
• Destany A Maddies
• Mary Louise Madison, MFTI
• Lilian Maina
• Brandt Maloney
• Martha-Marie Mansaray, FNP
• Takeisha Monique Maple
• Thomas Marino

• Addiction (Substance Use Disorder) Counselor in San Jacinto, CA
• Providers in San Jacinto, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.