Provider Demographics
NPI:1073136040
Name:WILMORE-NOZIL, AMELIA
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:
Last Name:WILMORE-NOZIL
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 1:12151 OLD SALEM CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-6258
Mailing Address - Country:US
Mailing Address - Phone:571-316-9075
Mailing Address - Fax:
Practice Address - Street 1:113 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-4273
Practice Address - Country:US
Practice Address - Phone:571-210-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health