Provider Demographics
NPI:1730843434
Name:WIMBERLY, EMANDA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:EMANDA
Middle Name:
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N UNIROYAL RD
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-9726
Mailing Address - Country:US
Mailing Address - Phone:334-703-9167
Mailing Address - Fax:
Practice Address - Street 1:810 N UNIROYAL RD
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36804-9726
Practice Address - Country:US
Practice Address - Phone:256-861-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4849C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical