MEDICARE: AMANI MCCOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	0701015662	VA

General Provider Information

NPI Number	:	1346104361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANI MCCOY

Provider Business Mailing Address
First Line	:	1320 CENTRAL PARK BLVD STE 412
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 CENTRAL PARK BLVD STE 412
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-4959
Country	:	US
Telephone Number	:	540-412-8613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2025
Last Update Date	:	12/13/2025

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