Provider Demographics
NPI:1720781495
Name:MCDONALD, AMY N (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:N
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 W MOREHEAD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5206
Mailing Address - Country:US
Mailing Address - Phone:980-785-4746
Mailing Address - Fax:
Practice Address - Street 1:1230 W MOREHEAD ST STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5206
Practice Address - Country:US
Practice Address - Phone:980-785-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0172001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical