Individual
AMY BANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
800 PRESTON AVE, CHARLOTTESVILLE, VA 22903-4420
(434) 972-1758
Mailing address
800 PRESTON AVE, CHARLOTTESVILLE, VA 22903-4420
(434) 972-1758
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0701005326
VA
Other
Enumeration date
09/21/2012
Last updated
09/21/2012
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