Provider Demographics
NPI:1396809869
Name:COMBS, AMY S (PSYD)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:S
Last Name:COMBS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 FAIRVIEW RD, STE 412
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210
Mailing Address - Country:US
Mailing Address - Phone:704-817-7643
Mailing Address - Fax:704-362-1170
Practice Address - Street 1:5970 FAIRVIEW RD, STE 412
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210
Practice Address - Country:US
Practice Address - Phone:704-817-7643
Practice Address - Fax:704-362-1170
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5825006OtherCIGNA
NC6000468Medicaid
NC046F8OtherNC STATE HEALTH PLAN
NC7916842OtherAETNA
NC046F8OtherBCBS OF NC