Provider Demographics
NPI:1114100112
Name:BLOUNT, AMY D (LPC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:D
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 SAPPHIRE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9079
Mailing Address - Country:US
Mailing Address - Phone:252-830-7540
Mailing Address - Fax:252-413-0932
Practice Address - Street 1:2245 STANTONSBURG RD
Practice Address - Street 2:STE. O
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2868
Practice Address - Country:US
Practice Address - Phone:252-752-0483
Practice Address - Fax:252-757-3172
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6788101YP2500X
NC1365101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103793Medicaid
416760OtherMHN