Provider Demographics
NPI:1841249448
Name:AMOS, VICTORIA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:A
Last Name:AMOS
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:PO BOX 5937
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37928-0937
Mailing Address - Country:US
Mailing Address - Phone:865-973-0663
Mailing Address - Fax:
Practice Address - Street 1:4741 N BROADWAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1793
Practice Address - Country:US
Practice Address - Phone:865-973-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0012441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3694833Medicaid
TN3131049OtherBLUE CROSS/BLUE SHIELD
TN3694833Medicare ID - Type Unspecified