Provider Demographics
NPI:1861973323
Name:HETRICK, AMANDA SHEREE (BA, RBT)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:SHEREE
Last Name:HETRICK
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 AMERICAN LEGION RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:757-319-4828
Practice Address - Street 1:3105 AMERICAN LEGION RD STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5653
Practice Address - Country:US
Practice Address - Phone:804-971-6903
Practice Address - Fax:757-319-4828
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician