Provider Demographics
NPI:1417451238
Name:WHITE, AMANDA REEVES (MSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:REEVES
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 PINE ST STE 9
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-1463
Mailing Address - Country:US
Mailing Address - Phone:276-730-3200
Mailing Address - Fax:
Practice Address - Street 1:605 PINE ST STE 9
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-1463
Practice Address - Country:US
Practice Address - Phone:276-730-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPROV-06473731041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool