Healthcare Provider Details

I. General information

NPI: 1104798990
Provider Name (Legal Business Name): AMBER M MCGILL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BELAIRE AVE STE 350
CHESAPEAKE VA
23320-4789
US

IV. Provider business mailing address

555 BELAIRE AVE STE 350
CHESAPEAKE VA
23320-4789
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019077
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: