Provider Demographics
NPI:1457135774
Name:WILBORN, AMANDA E (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:WILBORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4619 W SAGUARO DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-4424
Mailing Address - Country:US
Mailing Address - Phone:928-792-1357
Mailing Address - Fax:
Practice Address - Street 1:4619 W SAGUARO DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-4424
Practice Address - Country:US
Practice Address - Phone:928-792-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty