Provider Demographics
NPI:1407693732
Name:MCKENNA, AMANDA KATE (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATE
Last Name:MCKENNA
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 1:1331 MARYLAND AVE SW APT 1107
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2858
Mailing Address - Country:US
Mailing Address - Phone:202-329-9839
Mailing Address - Fax:
Practice Address - Street 1:8230 OLD COURTHOUSE RD STE 500
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3840
Practice Address - Country:US
Practice Address - Phone:703-281-2657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040170721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical