Provider Demographics
NPI:1740460989
Name:BABINEAU-LAROSE, AMANDA C (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:BABINEAU-LAROSE
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 1:312 E MARKET ST STE F
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4173
Mailing Address - Country:US
Mailing Address - Phone:703-493-0467
Mailing Address - Fax:
Practice Address - Street 1:312 E MARKET ST STE F
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4173
Practice Address - Country:US
Practice Address - Phone:703-493-0467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040078611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical