Provider Demographics
NPI:1043725385
Name:WARD, AMANDA J (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:WARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HARDYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23070-2130
Mailing Address - Country:US
Mailing Address - Phone:757-880-4143
Mailing Address - Fax:
Practice Address - Street 1:6810 TEAGLE LN
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-5386
Practice Address - Country:US
Practice Address - Phone:804-210-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health