=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891653473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLOW CREEK COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2026
-----------------------------------------------------
Last Update Date | 01/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 N MAIN ST STE 105
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22664-1851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-975-0787
-----------------------------------------------------
Fax | 571-210-1218
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4356 S OX RD
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22824-3629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-975-0787
-----------------------------------------------------
Fax | 571-210-1218
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | AMANDA PALMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-975-0787
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------