Provider Demographics
NPI:1013929033
Name:ELLIOTT, AMY W (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:W
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 JENSEN PL
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-9022
Mailing Address - Country:US
Mailing Address - Phone:540-384-6147
Mailing Address - Fax:
Practice Address - Street 1:4656 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3437
Practice Address - Country:US
Practice Address - Phone:540-772-8043
Practice Address - Fax:540-772-8242
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001842101YP2500X
VA0717000698106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010214424Medicaid
VA185569OtherANTHEM BCBS
VA025425OtherVALUE OPTIONS
MD151545000OtherMAGELLAN HEALTH
VA010214424OtherVA PREMIER