Provider Demographics
NPI:1619419322
Name:BELL AMISON, TAMARA ALEXIS (LPC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ALEXIS
Last Name:BELL AMISON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 VERONA DR
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3410
Mailing Address - Country:US
Mailing Address - Phone:330-717-1311
Mailing Address - Fax:
Practice Address - Street 1:8303 VERONA DR
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3410
Practice Address - Country:US
Practice Address - Phone:330-717-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005516390200000X
DCPRC14947101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program