Provider Demographics
NPI:1518259779
Name:PROKOPOWICZ, AMY J (MA,LCAS, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:J
Last Name:PROKOPOWICZ
Suffix:
Gender:F
Credentials:MA,LCAS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 COX AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-6352
Mailing Address - Country:US
Mailing Address - Phone:919-443-5704
Mailing Address - Fax:
Practice Address - Street 1:112 COX AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1817
Practice Address - Country:US
Practice Address - Phone:919-443-5704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
NCA8046101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health