Provider Demographics
NPI:1578187258
Name:SEITLIN, AMY JILL (LCMHCA, ATR-P)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JILL
Last Name:SEITLIN
Suffix:
Gender:F
Credentials:LCMHCA, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 FOLGER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-5947
Mailing Address - Country:US
Mailing Address - Phone:704-942-7888
Mailing Address - Fax:
Practice Address - Street 1:6901 FOLGER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-5947
Practice Address - Country:US
Practice Address - Phone:704-942-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X
NCA15711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist