Provider Demographics
NPI:1629113337
Name:GATCH, AMY A (LCSW, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:A
Last Name:GATCH
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 DATAW LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-2680
Mailing Address - Country:US
Mailing Address - Phone:704-661-7422
Mailing Address - Fax:
Practice Address - Street 1:2007 DATAW LN
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-2680
Practice Address - Country:US
Practice Address - Phone:704-661-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5743103K00000X
NCC0050351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-09-5743OtherBCBA
SC8863OtherLISW
NCC005035OtherLCSW