Provider Demographics
NPI:1558842088
Name:STILWELL, AMANDA L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:STILWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 COMMERCE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5231
Mailing Address - Country:US
Mailing Address - Phone:419-482-8382
Mailing Address - Fax:
Practice Address - Street 1:1070 COMMERCE DR STE 101
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5231
Practice Address - Country:US
Practice Address - Phone:419-482-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional