Provider Demographics
NPI:1083047476
Name:HOPPER, AMIE STELLA (LCAS, LCMHCS, CCS)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:STELLA
Last Name:HOPPER
Suffix:
Gender:F
Credentials:LCAS, LCMHCS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11709 FRUEHAUF DR STE 114
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-7285
Mailing Address - Country:US
Mailing Address - Phone:704-769-9789
Mailing Address - Fax:
Practice Address - Street 1:11709 FRUEHAUF DR STE 114
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-7285
Practice Address - Country:US
Practice Address - Phone:704-769-9789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3362-A101YA0400X
NC10409101YP2500X
NC3362101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3362AOtherNCSAPPB