Healthcare Provider Details

I. General information

NPI: 1720867583
Provider Name (Legal Business Name): AMANDO JOHN ESGUERRA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MUNDY LN
FREDERICKSBURG VA
22405-2880
US

IV. Provider business mailing address

20 MUNDY LN
FREDERICKSBURG VA
22405-2880
US

V. Phone/Fax

Practice location:
  • Phone: 571-236-4642
  • Fax:
Mailing address:
  • Phone: 571-236-4642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006701
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: