Provider Demographics
NPI:1295868644
Name:GARDNER, AMY K (LMFT)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:K
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 COURTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2926
Mailing Address - Country:US
Mailing Address - Phone:336-667-3333
Mailing Address - Fax:336-667-8749
Practice Address - Street 1:507 COURTHOUSE DRIVE
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697
Practice Address - Country:US
Practice Address - Phone:336-667-3333
Practice Address - Fax:336-667-8749
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5018AOtherMFTA
NC1190OtherLMFT