Provider Demographics
NPI:1558587410
Name:DAVID, AMY MAURA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MAURA
Last Name:DAVID
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 QUEENSWATER LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6557
Mailing Address - Country:US
Mailing Address - Phone:704-845-4606
Mailing Address - Fax:
Practice Address - Street 1:602 QUEENSWATER LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6557
Practice Address - Country:US
Practice Address - Phone:704-845-4606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0044861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical