Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY20304 | CA |
N | 103TC0700X | Clinical Psychologist | PSY20304 | CA |
Y | 103TC1900X | Counseling Psychologist | PSY20304 | CA |
NPI | 1114368792 |
---|---|
Provider Name | Dr. Amanda Louise Wood |
First Address | San Juan Capistrano, CA 92675-1423 |
Second Address | Mission Viejo, CA 92691-8551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2013 |
Last Update Date | 18/01/2018 |