Healthcare Provider Details

I. General information

NPI: 1184021842
Provider Name (Legal Business Name): AMANDA PLUMB LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 BATTLEFIELD BLVD N SUITE 260
CHESAPEAKE VA
23320-4516
US

IV. Provider business mailing address

1417 BATTLEFIELD BLVD N SUITE 260
CHESAPEAKE VA
23320-4516
US

V. Phone/Fax

Practice location:
  • Phone: 757-436-0605
  • Fax: 757-436-0023
Mailing address:
  • Phone: 757-436-0605
  • Fax: 757-436-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional
License Number0701005980
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: