Provider Demographics
NPI:1609198605
Name:D'AMICO, TINA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PATRICK HENRY DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2722
Mailing Address - Country:US
Mailing Address - Phone:804-698-9316
Mailing Address - Fax:888-972-5343
Practice Address - Street 1:2850 SANDY BAY RD STE 201B
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2362
Practice Address - Country:US
Practice Address - Phone:804-698-9316
Practice Address - Fax:888-972-5343
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040070751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical