Provider Demographics
NPI:1659531523
Name:GARCIA, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 N WENDOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1118
Mailing Address - Country:US
Mailing Address - Phone:704-376-7180
Mailing Address - Fax:704-376-0903
Practice Address - Street 1:6800 SAINT PETERS LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-8458
Practice Address - Country:US
Practice Address - Phone:704-536-0375
Practice Address - Fax:704-531-9266
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00358000101YP2500X
NC11020101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional