Provider Demographics
NPI:1700587003
Name:WILSON, AMANDA D (MSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 MS 7
Mailing Address - Street 2:
Mailing Address - City:OXORD
Mailing Address - State:MS
Mailing Address - Zip Code:35865
Mailing Address - Country:US
Mailing Address - Phone:662-234-7521
Mailing Address - Fax:662-236-3071
Practice Address - Street 1:152 MS 7
Practice Address - Street 2:
Practice Address - City:OXORD
Practice Address - State:MS
Practice Address - Zip Code:35865
Practice Address - Country:US
Practice Address - Phone:662-234-7521
Practice Address - Fax:662-236-3071
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health