Healthcare Provider Details

I. General information

NPI: 1144634312
Provider Name (Legal Business Name): AMANDA SOVIK-JOHNSTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 31ST ST S STE A
ARLINGTON VA
22206-1669
US

IV. Provider business mailing address

141 EDNAM DR STE 104
CHARLOTTESVILLE VA
22903-4629
US

V. Phone/Fax

Practice location:
  • Phone: 434-202-4080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005015
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: