MEDICARE: AMELIA WILKERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1770234767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA WILKERSON

Provider Business Mailing Address
First Line	:	1135 NW 23RD AVE STE D
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32609-3449
Country	:	US
Telephone Number	:	386-454-0660
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 NW 23RD AVE STE D
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32609-3449
Country	:	US
Telephone Number	:	386-454-0660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	01/12/2022

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Directions to “ AMELIA WILKERSON ” Practice Location

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