Provider Demographics
NPI:1255487161
Name:JAMIESON, AMY POWELL (MTS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:POWELL
Last Name:JAMIESON
Suffix:
Gender:F
Credentials:MTS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1798
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28106-1798
Mailing Address - Country:US
Mailing Address - Phone:704-771-1714
Mailing Address - Fax:704-771-1890
Practice Address - Street 1:1238 MANN DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5539
Practice Address - Country:US
Practice Address - Phone:704-552-0116
Practice Address - Fax:704-552-7550
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3971101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102269Medicaid
NC130V9OtherBLUE CROSS BLUE SHIELD NC