Provider Demographics
NPI:1730109398
Name:FONGEMIE, AMY LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:FONGEMIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 COLLEGE AVE STE 145N
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-2459
Mailing Address - Country:US
Mailing Address - Phone:828-202-2735
Mailing Address - Fax:
Practice Address - Street 1:2270 COLLEGE AVE STE 145
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-2459
Practice Address - Country:US
Practice Address - Phone:828-202-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0082831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical