Provider Demographics
NPI:1699349514
Name:SHREVE, AMBER LYNETTE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNETTE
Last Name:SHREVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-9666
Mailing Address - Country:US
Mailing Address - Phone:757-319-2273
Mailing Address - Fax:757-606-9606
Practice Address - Street 1:31494 CHAMPS DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-3839
Practice Address - Country:US
Practice Address - Phone:757-319-2273
Practice Address - Fax:757-606-9606
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010502101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional