Provider Demographics
NPI:1083187751
Name:WILKINSON, AMANDA SUE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:SUE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:CLARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:249 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-3258
Mailing Address - Country:US
Mailing Address - Phone:636-706-9559
Mailing Address - Fax:
Practice Address - Street 1:202 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1832
Practice Address - Country:US
Practice Address - Phone:636-706-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-05
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018043962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health