Provider Demographics
NPI:1639640063
Name:SNOW, AMANDA MARIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:SNOW
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CARMICHAEL WAY STE 604
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2489
Mailing Address - Country:US
Mailing Address - Phone:860-389-7000
Mailing Address - Fax:757-908-2320
Practice Address - Street 1:200 CARMICHAEL WAY STE 604
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-2489
Practice Address - Country:US
Practice Address - Phone:757-908-2124
Practice Address - Fax:757-903-2320
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177037163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health