Provider Demographics
NPI:1760515688
Name:DROZDA, AMY D (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:DROZDA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:DIANE
Other - Last Name:BANES CRAIG NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1503 SUITE E WAYNE MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2203
Mailing Address - Country:US
Mailing Address - Phone:919-587-0001
Mailing Address - Fax:919-587-0007
Practice Address - Street 1:1503 WAYNE MEMORIAL DR
Practice Address - Street 2:SUITE E
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2203
Practice Address - Country:US
Practice Address - Phone:919-587-0001
Practice Address - Fax:919-587-0007
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-065611041C0700X
NCC0081971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34280081Medicaid