Individual
AMANDA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8445 MUNSON RD, MENTOR, OH 44060-2410
(440) 255-1700
(440) 205-2417
Mailing address
8445 MUNSON RD, MENTOR, OH 44060-2410
(440) 255-1700
(440) 205-2417
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
187963
OH
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2864093
—
OH
Enumeration date
03/24/2022
Last updated
08/27/2024
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