Provider Demographics
NPI:1801546031
Name:WHITLOW, AMANDA NICOLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:NICOLE
Last Name:WHITLOW
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 1:1248 CARMIA WAY #1145
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3825
Mailing Address - Country:US
Mailing Address - Phone:804-292-1836
Mailing Address - Fax:804-409-7536
Practice Address - Street 1:11237 MAGILL TERRACE DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-6150
Practice Address - Country:US
Practice Address - Phone:804-292-1836
Practice Address - Fax:804-409-7536
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040135721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical