Amanda Bowers Grizzard, LPC LMFT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701002570 Issued in VA

Practice address

644 Independence Pkwy Ste 200
Chesapeake, VA 23320-5212

Phone

(757) 547-1811

Fax

(757) 547-1811

NPI assigned

Sep 27, 2006

Last updated

Apr 17, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Amanda Coreen Bowers Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Restorer of Broken Walls PC

  • Counselor
  • Chesapeake, VA
  • NPI 1811080047
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1356432579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 INDEPENDENCE PKWY STE 200",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233205212",
            "telephone_number": "757-547-1811",
            "fax_number": "757-547-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 INDEPENDENCE PKWY STE 200",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233205212",
            "telephone_number": "757-547-1811",
            "fax_number": "757-547-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIZZARD",
        "first_name": "AMANDA",
        "middle_name": "BOWERS",
        "name_prefix": "Mrs.",
        "credential": "LPC LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701002570",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "VA",
            "license": "0717000300",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "236537",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "323829",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005415144",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "BOWERS",
            "middle_name": "COREEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Baylea Renee Grimes, MA
• Michael P Grimes, MD
• Kenneth E. Grindlay, D.D.S.
• Hollieann Katherine Gripp, CRNA
• Grit Healthcare Solutions, LLC
• Sarah Mae Groft, PA-C
• Patricia J Grogan, MD
• Carlie Gross
• Fredric Jay Gross, M.D.
• Katherine Farrell Gross, PA-C

• Professional Counselor in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.