Provider Demographics
NPI:1497254924
Name:TADDEO, AMY (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:TADDEO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 STERLING RD STE 203
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3873
Mailing Address - Country:US
Mailing Address - Phone:703-466-5150
Mailing Address - Fax:
Practice Address - Street 1:1031 STERLING RD STE 203
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3873
Practice Address - Country:US
Practice Address - Phone:703-466-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA701010395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health