Provider Demographics
NPI:1134683238
Name:HASTY-RHODES, AMELIA CARMEL (MSW LCSWA, LCASR)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:CARMEL
Last Name:HASTY-RHODES
Suffix:
Gender:F
Credentials:MSW LCSWA, LCASR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SAINT JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-9014
Mailing Address - Country:US
Mailing Address - Phone:704-433-1676
Mailing Address - Fax:
Practice Address - Street 1:303 SAINT JOHNS DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-9014
Practice Address - Country:US
Practice Address - Phone:704-433-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25240101YA0400X
NCP0131731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)