| NPI | 1538552013 |
|---|---|
| Former Name | AMANDA JO WILCOX |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1980) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MT 101YA0400X) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2025-08-13 |