Provider Demographics
NPI:1205101854
Name:PEREZ, AMELIA N (MA)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:N
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14011 HAVEN RIDGE LN
Mailing Address - Street 2:UNIT 203
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7818
Mailing Address - Country:US
Mailing Address - Phone:704-928-5434
Mailing Address - Fax:
Practice Address - Street 1:14011 HAVEN RIDGE LN
Practice Address - Street 2:UNIT 203
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7818
Practice Address - Country:US
Practice Address - Phone:704-928-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor