Provider Demographics
NPI:1821867524
Name:AMANDA SOVIK-JOHNSTON
Entity Type:Organization
Organization Name:AMANDA SOVIK-JOHNSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-202-4080
Mailing Address - Street 1:141 EDNAM DR STE 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4629
Mailing Address - Country:US
Mailing Address - Phone:434-202-4080
Mailing Address - Fax:
Practice Address - Street 1:141 EDNAM DR STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4629
Practice Address - Country:US
Practice Address - Phone:434-202-4080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty