Provider Demographics
NPI:1497807515
Name:MOCK, AMY LEIGH (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:MOCK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W MOREHEAD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5271
Mailing Address - Country:US
Mailing Address - Phone:704-497-0824
Mailing Address - Fax:
Practice Address - Street 1:2301 W MOREHEAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5271
Practice Address - Country:US
Practice Address - Phone:704-497-0824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5327101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103263Medicaid