Provider Demographics
NPI:1356432579
Name:GRIZZARD, AMANDA BOWERS (LPC LMFT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BOWERS
Last Name:GRIZZARD
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:COREEN
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:644 INDEPENDENCE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5212
Mailing Address - Country:US
Mailing Address - Phone:757-547-1811
Mailing Address - Fax:757-547-1811
Practice Address - Street 1:644 INDEPENDENCE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5212
Practice Address - Country:US
Practice Address - Phone:757-547-1811
Practice Address - Fax:757-547-1811
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000300106H00000X
VA0701002570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005415144Medicaid
236537OtherANTHEM
323829OtherTRICARE