Provider Demographics
NPI:1528395191
Name:KUSTERER, AMANDA A (BCABA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:KUSTERER
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COALFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4403
Mailing Address - Country:US
Mailing Address - Phone:804-897-7440
Mailing Address - Fax:804-897-7441
Practice Address - Street 1:400 COALFIELD RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4403
Practice Address - Country:US
Practice Address - Phone:804-897-7440
Practice Address - Fax:804-897-7441
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0-08-2482103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst