Provider Demographics
NPI:1306002019
Name:DATLA, AMY LANIER (LCMHCS, LMHC, LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LANIER
Last Name:DATLA
Suffix:
Gender:F
Credentials:LCMHCS, LMHC, LMFT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LANIER
Other - Last Name:GUMPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, CAP, NCC
Mailing Address - Street 1:3 MOUNT OLIVE TER
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2987
Mailing Address - Country:US
Mailing Address - Phone:813-808-1956
Mailing Address - Fax:888-977-1272
Practice Address - Street 1:3 MOUNT OLIVE TER
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2987
Practice Address - Country:US
Practice Address - Phone:813-808-1956
Practice Address - Fax:888-977-1272
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2809106H00000X
FLMH8831101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1285977520OtherNPPES- NPI #