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General NPI Number Information
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NPI Number | 1609198605
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Entity Type | Individual
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Provider Name | TINA MARIE D'AMICO L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 2850 SANDY BAY RD STE 201B
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-2362
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Country | US
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Telephone | 804-698-9316
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Fax | 888-972-5343
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Provider Business Mailing Address
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Address Line | 108 PATRICK HENRY DR
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-2722
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Country | US
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Telephone | 804-698-9316
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Fax | 888-972-5343
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007075
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License Number State | VA
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