| Doctor Name: | AMIE JO WILSON |
| NPI Number: | 1275962458 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCC |
| License Number: | 104785 |
| Business Practice Address: | 500 New Start Rd Bronston, KY - 425188572 |
| Business Phone Number: | 6065615797 |
| Business Fax Number: | 6065619928 |
| Mailing Address: | 300 Hope St, MT WASHINGTON |
| State: | KY |
| Postal Code: | 400477757 |
| Phone Number: | 5025381000 |
| Fax Number: | 5025381100 |
| NPI Enumeration Date: | 11/07/2013 |
| NPI Last Update Date: | 06/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 104785 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |