Provider Demographics
NPI:1730563842
Name:BEVERLY, AMANDA HARMON (LPC, CSOTP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:HARMON
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:LPC, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 HALES FORD RD
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-5473
Mailing Address - Country:US
Mailing Address - Phone:540-400-9359
Mailing Address - Fax:
Practice Address - Street 1:5427 PETERS CREEK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-3858
Practice Address - Country:US
Practice Address - Phone:540-523-8080
Practice Address - Fax:540-562-8867
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional