Provider Demographics
NPI:1255205027
Name:CASEBOLT, AMANDA (RBT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CASEBOLT
Suffix:
Gender:F
Credentials:RBT
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 244
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-0244
Mailing Address - Country:US
Mailing Address - Phone:804-581-0008
Mailing Address - Fax:804-404-9550
Practice Address - Street 1:621 CRALLE AVE
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-2230
Practice Address - Country:US
Practice Address - Phone:804-456-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VABACB1425205106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician