Provider Demographics
NPI:1255688693
Name:WHEELOCK, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WHEELOCK
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 1:161 SUMMER ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1275
Mailing Address - Country:US
Mailing Address - Phone:508-962-5772
Mailing Address - Fax:508-746-5031
Practice Address - Street 1:161 SUMMER ST STE 3B
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1275
Practice Address - Country:US
Practice Address - Phone:508-962-5772
Practice Address - Fax:508-746-5031
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor