MEDICARE: MS. AMANDA FRANCES WILKINSON LPCC

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	101YP2500X	Professional Counselor	353	CA

General Provider Information

NPI Number	:	1831536358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA FRANCES WILKINSON LPCC

Provider Business Mailing Address
First Line	:	5540 GREEN VALLEY RD
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-9457
Country	:	US
Telephone Number	:	310-266-3183
Fax Number	:

Provider Business Practice Location Address
First Line	:	3332 HEIGHTS DR STE 235
Second Line	:
City	:	CAMERON PARK
State	:	CA
Zip	:	95682-7774
Country	:	US
Telephone Number	:	530-350-7418
Fax Number	:

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

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	07/29/2019

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