Provider Demographics
NPI:1972807659
Name:DOMBROSKY, AMY HALL (LCMHC, NCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:HALL
Last Name:DOMBROSKY
Suffix:
Gender:F
Credentials:LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14109 PROMENADE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6685
Mailing Address - Country:US
Mailing Address - Phone:704-629-8306
Mailing Address - Fax:
Practice Address - Street 1:14109 PROMENADE DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6685
Practice Address - Country:US
Practice Address - Phone:704-629-8306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002726101YP2500X
NC7783101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6104698Medicaid