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Organization
CLEANSLATE CENTERS, LLC
Active
Organization
CLEANSLATE CENTERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMANDA L WILSON MD (OWNER)
(413) 788-0100
Entity
Organization
Contact information
Practice address
82 MAIN ST, WEST SPRINGFIELD, MA 01089-3942
(413) 788-0100
(413) 736-1813
Mailing address
PO BOX 32, NORTHAMPTON, MA 01061
(413) 788-0100
(413) 736-1813
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
NULL
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
104100000X
Social Worker
—
NULL
104100000X
Social Worker
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
NULL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
NULL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
Other
Enumeration date
06/03/2010
Last updated
06/09/2010
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