Provider Demographics
NPI:1811781206
Name:ENROUGHTY, AMY SHEPHERD (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SHEPHERD
Last Name:ENROUGHTY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1812 BELLOWS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-7475
Mailing Address - Country:US
Mailing Address - Phone:804-514-1769
Mailing Address - Fax:
Practice Address - Street 1:1812 BELLOWS DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-7475
Practice Address - Country:US
Practice Address - Phone:804-514-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040179261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical