Provider Demographics
NPI:1306184106
Name:RUDD, AMY HAMPTON (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:HAMPTON
Last Name:RUDD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 E GARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5115
Mailing Address - Country:US
Mailing Address - Phone:704-864-6573
Mailing Address - Fax:704-864-9791
Practice Address - Street 1:1209 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5115
Practice Address - Country:US
Practice Address - Phone:704-864-6573
Practice Address - Fax:704-864-9791
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0081321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical