Provider Demographics
NPI:1891164869
Name:AMY CLECKLER
Entity Type:Organization
Organization Name:AMY CLECKLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEND CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, MSW, LCSW
Authorized Official - Phone:919-943-0405
Mailing Address - Street 1:809 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2210
Mailing Address - Country:US
Mailing Address - Phone:919-943-0405
Mailing Address - Fax:
Practice Address - Street 1:809 NORTH ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2210
Practice Address - Country:US
Practice Address - Phone:919-943-0405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC006034305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service