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General NPI Number Information
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NPI Number | 1700154523
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Entity Type | Individual
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Provider Name | AMBER EASON LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 505 S INDEPENDENCE BLVD STE 213
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1150
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Country | US
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Telephone | 757-376-8167
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Fax |
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Provider Business Mailing Address
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Address Line | 505 S INDEPENDENCE BLVD STE 213
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1150
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Country | US
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Telephone | 757-376-8167
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Fax | 757-452-4447
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904011246
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License Number State | VA
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