Provider Demographics
NPI:1124279765
Name:WILSON, AMY NAMES (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NAMES
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 OAKLAND DR STE D
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3998
Mailing Address - Country:US
Mailing Address - Phone:269-216-9289
Mailing Address - Fax:269-256-5588
Practice Address - Street 1:3018 OAKLAND DR STE D
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3998
Practice Address - Country:US
Practice Address - Phone:269-216-9289
Practice Address - Fax:269-775-1266
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010896851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical