Individual
AMANDA YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SERVICES FACILITATOR
Contact information
Practice address
606 BROAD ST STE F, SOUTH BOSTON, VA 24592-3200
(434) 575-5200
(434) 575-5054
Mailing address
PO BOX 776, SOUTH BOSTON, VA 24592-0776
(434) 575-5200
(434) 575-5054
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619053667
—
VA
Enumeration date
02/14/2018
Last updated
02/14/2018
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