Provider Demographics
NPI:1760013718
Name:PROCTOR, EMILY ANN (LCMHC-A, LCAS-A, NCC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:LCMHC-A, LCAS-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5809
Mailing Address - Country:US
Mailing Address - Phone:336-870-5636
Mailing Address - Fax:
Practice Address - Street 1:124 TILLEY RD
Practice Address - Street 2:
Practice Address - City:VILAS
Practice Address - State:NC
Practice Address - Zip Code:28692-8398
Practice Address - Country:US
Practice Address - Phone:336-870-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25831101YA0400X
NCA15316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)