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General NPI Number Information
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NPI Number | 1821715350
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Entity Type | Individual
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Provider Name | DR. AMY GRACE BAKER SPROUL
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Gender | Female
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Dates
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Enumeration Date | 10/25/2022
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 3900 RESERVOIR RD NW
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City | WASHINGTON
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State | DC
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Zip | 20007-2126
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Country | US
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Telephone | 202-687-6985
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Fax |
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Provider Business Mailing Address
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Address Line | 2317 TRITON DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-3335
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Country | US
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Telephone | 804-837-3449
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | NONE
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License Number State | MA
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