Provider Demographics
NPI:1316683014
Name:DESELDING, AMANDA HELEN (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:HELEN
Last Name:DESELDING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:HELEN
Other - Last Name:DESELDING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:802 STREAMSIDE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2122
Mailing Address - Country:US
Mailing Address - Phone:757-652-0448
Mailing Address - Fax:
Practice Address - Street 1:850 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3300
Practice Address - Country:US
Practice Address - Phone:757-333-6992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040138401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical