Provider Demographics
NPI:1538685730
Name:JOLLY, AMY V (LCMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:V
Last Name:JOLLY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 LOCUST COVE RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-7871
Mailing Address - Country:US
Mailing Address - Phone:828-230-3854
Mailing Address - Fax:828-724-7757
Practice Address - Street 1:5623 US 221 S
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-7028
Practice Address - Country:US
Practice Address - Phone:828-437-3000
Practice Address - Fax:828-437-4999
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13158101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA13158OtherLICENSURE