Provider Demographics
NPI:1538055488
Name:IZADI LOWERY, AMITIS
Entity type:Individual
Prefix:
First Name:AMITIS
Middle Name:
Last Name:IZADI LOWERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14258 NEWBERN LOOP
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-1451
Mailing Address - Country:US
Mailing Address - Phone:571-299-7323
Mailing Address - Fax:
Practice Address - Street 1:9379 FORESTWOOD LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4760
Practice Address - Country:US
Practice Address - Phone:703-909-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133004419103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst