Doctor Name: | AMANDA ONEAL-EDELEN |
NPI Number: | 1013396134 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1849 |
Business Practice Address: | 2084 Main St Willisburg, KY - 400788199 |
Business Phone Number: | 8593759200 |
Business Fax Number: | 8593759202 |
Mailing Address: | Po Box 188, WILLISBURG |
State: | KY |
Postal Code: | 400780188 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/21/2015 |
NPI Last Update Date: | 05/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 1849 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |