Healthcare Provider Details

I. General information

NPI: 1508561226
Provider Name (Legal Business Name): AMANDA MEFFERT LRIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5768 BENFORD DR
HAYMARKET VA
20169-2503
US

IV. Provider business mailing address

42049 VICTORY LN
LEESBURG VA
20176-6322
US

V. Phone/Fax

Practice location:
  • Phone: 276-639-0332
  • Fax:
Mailing address:
  • Phone: 704-554-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704014470
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: