Provider Demographics
NPI:1215206040
Name:PILESKI, AMANDA H (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:H
Last Name:PILESKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:H
Other - Last Name:PILESKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:851 HIGHWAY 441 S STE 105
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-6264
Mailing Address - Country:US
Mailing Address - Phone:706-782-1237
Mailing Address - Fax:404-393-0737
Practice Address - Street 1:851 HIGHWAY 441 S STE 105
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-6264
Practice Address - Country:US
Practice Address - Phone:706-782-1237
Practice Address - Fax:404-393-0737
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003905103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA45-4106837OtherITIN