Healthcare Provider Details

I. General information

NPI: 1619419322
Provider Name (Legal Business Name): TAMARA ALEXIS BELL AMISON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 VERONA DR
NEW CARROLLTON MD
20784-3410
US

IV. Provider business mailing address

8303 VERONA DR
NEW CARROLLTON MD
20784-3410
US

V. Phone/Fax

Practice location:
  • Phone: 330-717-1311
  • Fax:
Mailing address:
  • Phone: 330-717-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPRC14947
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberAPC005516
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: