Provider Demographics
NPI:1497404891
Name:KAUFFMAN, AMY DANAE RHOADS (LMFTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DANAE RHOADS
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:DANAE
Other - Last Name:RHOADS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4726 PARK RD STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3375
Mailing Address - Country:US
Mailing Address - Phone:704-776-2464
Mailing Address - Fax:
Practice Address - Street 1:4726 PARK RD STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3375
Practice Address - Country:US
Practice Address - Phone:704-776-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12408A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist