Healthcare Provider Details

I. General information

NPI: 1750212593
Provider Name (Legal Business Name): AMY PHILLIPS RUDIGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ATLANTIC SHORES DR
VIRGINIA BEACH VA
23454-7311
US

IV. Provider business mailing address

1200 ATLANTIC SHORES DR
VIRGINIA BEACH VA
23454-7311
US

V. Phone/Fax

Practice location:
  • Phone: 757-721-1302
  • Fax: 757-716-2013
Mailing address:
  • Phone: 757-721-1302
  • Fax: 757-716-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020532
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: