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General NPI Number Information
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NPI Number | 1538754114
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Entity Type | Individual
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Provider Name | AMY L ANTONELLI CSAC
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Gender | Female
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 3630 S PLAZA TRL STE 150A
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3371
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Country | US
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Telephone | 757-985-6116
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Fax |
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Provider Business Mailing Address
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Address Line | 825 WINDOM PL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3416
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Country | US
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Telephone | 757-985-6116
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710103542
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701010376
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License Number State | VA
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