MEDICARE: MS. AMY MICHELLE ECHSTENKAMPER MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P007669	NC

General Provider Information

NPI Number	:	1114261286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY MICHELLE ECHSTENKAMPER MSW, LCSW

Provider Business Mailing Address
First Line	:	619 W 24TH ST APT 205
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-1235
Country	:	US
Telephone Number	:	919-423-3153
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 FIRST COLONIAL RD STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2263
Country	:	US
Telephone Number	:	757-568-5582
Fax Number	:	757-578-8237

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	03/16/2022

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