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General NPI Number Information
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NPI Number | 1497116875
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Entity Type | Individual
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Provider Name | AMY VITACOLONNA MS
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Gender | Female
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 117 INDIAN WARRIOR TRL
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City | LAKE JACKSON
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State | TX
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Zip | 77566-3253
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Country | US
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Telephone | 360-349-8775
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Fax | 843-897-0100
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Provider Business Mailing Address
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Address Line | PO BOX 15
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City | ANGLETON
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State | TX
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Zip | 77516-0015
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Country | US
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Telephone | 360-349-8775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH60943631
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License Number State | WA
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