Provider Demographics
NPI:1609223783
Name:THENOR, AMANDA LILLIAN
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LILLIAN
Last Name:THENOR
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 1:161 BUSH RIVER DR
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-3183
Mailing Address - Country:US
Mailing Address - Phone:434-392-6455
Mailing Address - Fax:434-392-9221
Practice Address - Street 1:161 BUSH RIVER DR
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-3183
Practice Address - Country:US
Practice Address - Phone:434-392-6455
Practice Address - Fax:434-392-9221
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904013501101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health