Individual
MRS. AMANDA PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
648 INDEPENDENCE PKWY STE 400, CHESAPEAKE, VA 23320-5207
(757) 420-0530
Mailing address
833 CREEKSIDE CRES, CHESAPEAKE, VA 23320-9263
(757) 202-5291
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701007584
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0812000791
CSOTP
VA
Enumeration date
04/18/2018
Last updated
11/09/2021
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