Individual
AMY VITACOLONNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
117 INDIAN WARRIOR TRL, LAKE JACKSON, TX 77566-3253
(360) 349-8775
(843) 897-0100
Mailing address
PO BOX 15, ANGLETON, TX 77516-0015
(360) 349-8775
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LH60943631
WA
101YM0800X
Mental Health Counselor
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8246
SOUTH CAROLINA LICENSING BOARD FOR COUNSELORS
SC
01
—
85-2743925
IRS
WA
01
—
95893
TEXAS BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS
TX
01
—
LH60943631
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
03/14/2016
Last updated
04/08/2025
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