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NPI Code Detail

MEDICARE: AMANDA WILSON ALC, MFT-A, NCC

MEDICARE: AMANDA WILSON ALC, MFT-A, NCC
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
1101YP2500XProfessional CounselorALC04738AL
2101YP2500XProfessional CounselorMFTA374AL

General Provider Information

NPI Number : 1770326175
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA WILSON ALC, MFT-A, NCC
Provider Business Mailing Address
First Line : 2013 KENTUCKY AVE
Second Line :
City : VESTAVIA HILLS
State : AL
Zip : 35216-1952
Country : US
Telephone Number : 205-440-1992
Fax Number :
Provider Business Practice Location Address
First Line : 2013 KENTUCKY AVE
Second Line :
City : VESTAVIA HILLS
State : AL
Zip : 35216-1952
Country : US
Telephone Number : 205-440-1992
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2024
Last Update Date : 03/05/2026

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