Provider Demographics
NPI:1548870496
Name:WOLFE, AMANDA NIELS LEIGHTON (PSYD TRAINEE)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NIELS LEIGHTON
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PSYD TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 TAYLOR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2289
Mailing Address - Country:US
Mailing Address - Phone:925-608-6550
Mailing Address - Fax:
Practice Address - Street 1:391 TAYLOR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2289
Practice Address - Country:US
Practice Address - Phone:925-608-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program