Individual
MRS. AMY W ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LMFT
Contact information
Practice address
4656 BRAMBLETON AVE, ROANOKE, VA 24018-3437
(540) 772-8043
(540) 772-8242
Mailing address
3502 JENSEN PL, SALEM, VA 24153-9022
(540) 384-6147
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701001842
VA
106H00000X
Marriage & Family Therapist
0717000698
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010214424
VA PREMIER
VA
05
—
010214424
—
VA
01
—
025425
VALUE OPTIONS
VA
01
—
151545000
MAGELLAN HEALTH
MD
01
—
185569
ANTHEM BCBS
VA
Enumeration date
08/12/2006
Last updated
09/26/2008
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