Provider Demographics
NPI:1699227470
Name:HEREFORD, AMY BOOR (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BOOR
Last Name:HEREFORD
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:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:22943-0302
Mailing Address - Country:US
Mailing Address - Phone:434-960-4334
Mailing Address - Fax:434-328-2951
Practice Address - Street 1:1001 E MARKET ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5381
Practice Address - Country:US
Practice Address - Phone:434-960-4334
Practice Address - Fax:434-328-2951
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040096151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical