Provider Demographics
NPI:1255575882
Name:DAVIS, AMANDA CAROL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CAROL
Last Name:DAVIS
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 1:3123 W GRACE ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-1449
Mailing Address - Country:US
Mailing Address - Phone:757-724-2256
Mailing Address - Fax:
Practice Address - Street 1:7303 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5805
Practice Address - Country:US
Practice Address - Phone:804-674-9375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040069851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical