Provider Demographics
NPI:1396971396
Name:WILKINS, AMANDA MARLOWE (LCMHC, NCC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARLOWE
Last Name:WILKINS
Suffix:
Gender:F
Credentials:LCMHC, NCC
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:AMANDA
Other - Last Name:MARLOWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:117 E OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-2719
Mailing Address - Country:US
Mailing Address - Phone:910-642-8393
Mailing Address - Fax:910-207-6326
Practice Address - Street 1:102 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4012
Practice Address - Country:US
Practice Address - Phone:910-518-0432
Practice Address - Fax:910-207-6326
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2118101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104293Medicaid