Provider Demographics
NPI:1437160652
Name:MOULDS, AMY BENTON (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BENTON
Last Name:MOULDS
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 PEMBERTON HILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4269
Mailing Address - Country:US
Mailing Address - Phone:919-303-0273
Mailing Address - Fax:919-303-5986
Practice Address - Street 1:1091 PEMBERTON HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4269
Practice Address - Country:US
Practice Address - Phone:919-303-0273
Practice Address - Fax:919-303-5986
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3648101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127VTOtherBCBS PROVIDER ID