Basic Information
| Provider Information | |||||||||
| NPI: | 1205033255 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOLARD | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MS, CRC, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 SAPPHIRE CT | ||||||||
| Address2: | STE 110 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278349019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528307540 | ||||||||
| FaxNumber: | 2527520074 | ||||||||
| Practice Location | |||||||||
| Address1: | 2245 STANTONSBURG RD | ||||||||
| Address2: | STE O | ||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278342868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527520483 | ||||||||
| FaxNumber: | 2527573172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 09/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6949 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 6103846 | 05 | NC | MEDICAID |