Provider Demographics
NPI:1891394839
Name:AMANDA FIRESTONE LLC
Entity Type:Organization
Organization Name:AMANDA FIRESTONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-517-3354
Mailing Address - Street 1:2804 GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-3629
Mailing Address - Country:US
Mailing Address - Phone:202-256-1116
Mailing Address - Fax:
Practice Address - Street 1:2804 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-3629
Practice Address - Country:US
Practice Address - Phone:202-256-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty