Provider Demographics
NPI:1184021842
Name:PLUMB, AMANDA (LPC,CCTP,CATP,CGCS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PLUMB
Suffix:
Gender:F
Credentials:LPC,CCTP,CATP,CGCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 GREENBRIER CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2645
Mailing Address - Country:US
Mailing Address - Phone:757-301-8747
Mailing Address - Fax:
Practice Address - Street 1:816 GREENBRIER CIR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2642
Practice Address - Country:US
Practice Address - Phone:757-694-4723
Practice Address - Fax:757-301-8803
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005980101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30016735730006Medicaid