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NPI Code Detail

MEDICARE: AMANDA L WOOLLARD MA LPC, LLC

MEDICARE: AMANDA L WOOLLARD MA LPC, LLC
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
11041C0700XClinical Social Worker
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1831873504
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMANDA L WOOLLARD MA LPC, LLC
Provider Business Mailing Address
First Line : 8539 TALMA CT
Second Line :
City : AFFTON
State : MO
Zip : 63123-3633
Country : US
Telephone Number : 618-604-8326
Fax Number :
Provider Business Practice Location Address
First Line : 4121 UNION RD STE 225
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-1093
Country : US
Telephone Number : 314-730-6787
Fax Number : 314-730-6585
Authorized Official
Title or Position : OWNER
Name : AMANDA L WOOLLARD
Credential : LPC
Telephone Number : 618-604-8326
Provider Enumeration Date : 06/13/2023
Last Update Date : 06/13/2023

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