Healthcare Provider Details

I. General information

NPI: 1407152465
Provider Name (Legal Business Name): AMY LOVELESS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23164 DRAGOON RD
LIGNUM VA
22726-2036
US

IV. Provider business mailing address

23164 DRAGOON RD
LIGNUM VA
22726-2036
US

V. Phone/Fax

Practice location:
  • Phone: 540-399-5081
  • Fax:
Mailing address:
  • Phone: 540-399-5081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004376
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: