Provider Demographics
NPI:1235663691
Name:LOWER, AMELIA ROSE (LPCA)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:ROSE
Last Name:LOWER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:ROSE
Other - Last Name:MITZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA
Mailing Address - Street 1:4000 WAKE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6879
Mailing Address - Country:US
Mailing Address - Phone:330-518-1513
Mailing Address - Fax:
Practice Address - Street 1:4000 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6879
Practice Address - Country:US
Practice Address - Phone:330-518-1513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health