Provider Demographics
NPI:1700814043
Name:KNOWLES, AMY K (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9409 HULL STREET RD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1200
Mailing Address - Country:US
Mailing Address - Phone:804-745-2225
Mailing Address - Fax:804-745-2242
Practice Address - Street 1:9409 HULL STREET RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-1200
Practice Address - Country:US
Practice Address - Phone:804-745-2225
Practice Address - Fax:804-745-2242
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040043361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA77-03325Medicaid
VAP29019Medicare UPIN