Provider Demographics
NPI:1205033255
Name:WOOLARD, AMANDA T (MS, CRC, LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:T
Last Name:WOOLARD
Suffix:
Gender:F
Credentials:MS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 SAPPHIRE CT
Mailing Address - Street 2:STE 110
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9019
Mailing Address - Country:US
Mailing Address - Phone:252-830-7540
Mailing Address - Fax:252-752-0074
Practice Address - Street 1:2245 STANTONSBURG RD
Practice Address - Street 2:STE O
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2868
Practice Address - Country:US
Practice Address - Phone:252-752-0483
Practice Address - Fax:252-757-3172
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103846Medicaid