Provider Demographics
NPI:1720442049
Name:LANCASTER, AMY (CSAC 20335)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:CSAC 20335
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748-5646
Mailing Address - Country:US
Mailing Address - Phone:828-318-0148
Mailing Address - Fax:
Practice Address - Street 1:631 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NC
Practice Address - Zip Code:28748-5646
Practice Address - Country:US
Practice Address - Phone:828-318-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20335101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)