Provider Demographics
NPI:1487099487
Name:WOLFE, AMANDA LEIGH (LPC, RPT, CDC 1)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LPC, RPT, CDC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:2250 S WOODWORTH LOOP
Practice Address - Street 2:SUITE 202
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7457
Practice Address - Country:US
Practice Address - Phone:907-761-5800
Practice Address - Fax:907-761-5801
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3935101YA0400X
AK112995101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)