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General NPI Number Information
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NPI Number | 1215491386
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Entity Type | Individual
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Provider Name | AMANDA LALLY LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 1405 BRENTWOOD PKWY NE
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City | WASHINGTON
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State | DC
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Zip | 20002-2220
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Country | US
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Telephone | 225-249-9594
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Fax |
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Provider Business Mailing Address
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Address Line | 64 H ST SW APT 1228
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City | WASHINGTON
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State | DC
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Zip | 20024-0457
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Country | US
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Telephone | 225-249-9594
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | LC200003260
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License Number State | DC
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