Provider Demographics
NPI:1508561226
Name:MEFFERT, AMANDA (LRIC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MEFFERT
Suffix:
Gender:F
Credentials:LRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42049 VICTORY LN
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6322
Mailing Address - Country:US
Mailing Address - Phone:704-554-6300
Mailing Address - Fax:
Practice Address - Street 1:5768 BENFORD DR
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2503
Practice Address - Country:US
Practice Address - Phone:276-639-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014470101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health