Provider Demographics
NPI:1265630347
Name:PENNY, AMPARO (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:AMPARO
Middle Name:
Last Name:PENNY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 DUTCH COVE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-9183
Mailing Address - Country:US
Mailing Address - Phone:919-522-2498
Mailing Address - Fax:
Practice Address - Street 1:1 VILLAGE LN STE 3
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2617
Practice Address - Country:US
Practice Address - Phone:828-708-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103640Medicaid