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Individual

AMANDA GRACE KEPHART

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
11260 ROGER BACON DR STE 103, RESTON, VA 20190-5203
(855) 284-7483
(617) 807-0958
Mailing address
PO BOX 748465, ATLANTA, GA 30374-8465
(855) 284-7483
(617) 807-0958

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LH61688079
WA
101YP2500X
Professional Counselor
Primary
0701012428
VA
101YP2500X
Professional Counselor
0704013790
VA

Other

Enumeration date
01/04/2023
Last updated
01/12/2026
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