Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701003718 | VA |
NPI | 1003838400 |
---|---|
Provider Name | Mrs. Amanda C Kizer |
First Address | Stuart's Draft, VA 24477-6712 |
Second Address | Stuart's Draft, VA 24477-6712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
088067M | SENTARA (01) | VA |