Provider Demographics
NPI:1982969713
Name:SMALL, AMY TOLER (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:TOLER
Last Name:SMALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3111 NORTHSIDE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5441
Mailing Address - Country:US
Mailing Address - Phone:804-614-7361
Mailing Address - Fax:855-710-7582
Practice Address - Street 1:3111 NORTHSIDE AVE STE 101
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-5441
Practice Address - Country:US
Practice Address - Phone:804-617-4361
Practice Address - Fax:855-710-7582
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701005057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional