Healthcare Provider Details

I. General information

NPI: 1790275733
Provider Name (Legal Business Name): AMANDA HANTZSCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10565 FAIRFAX BLVD STE 300
FAIRFAX VA
22030-3104
US

IV. Provider business mailing address

245 WESTONIA RD
CHESAPEAKE VA
23323-1823
US

V. Phone/Fax

Practice location:
  • Phone: 703-218-6599
  • Fax:
Mailing address:
  • Phone: 252-435-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: