Provider Demographics
NPI:1437478815
Name:HEARN, AMANDA (MA, CAGS, NCSP)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:HEARN
Suffix:
Gender:F
Credentials:MA, CAGS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46179 WESTLAKE DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5874
Mailing Address - Country:US
Mailing Address - Phone:703-314-5267
Mailing Address - Fax:
Practice Address - Street 1:46179 WESTLAKE DR
Practice Address - Street 2:SUITE 330
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5874
Practice Address - Country:US
Practice Address - Phone:703-314-5267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0803000236103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool