Provider Demographics
NPI:1780914804
Name:ROYSTER, AMELIA LANETTE (LPC, LCAS)
Entity type:Individual
Prefix:MISS
First Name:AMELIA
Middle Name:LANETTE
Last Name:ROYSTER
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58411
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27658-8411
Mailing Address - Country:US
Mailing Address - Phone:888-870-4935
Mailing Address - Fax:888-870-4935
Practice Address - Street 1:3200 SPRING FOREST RD
Practice Address - Street 2:STE. 206
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-2811
Practice Address - Country:US
Practice Address - Phone:888-870-4935
Practice Address - Fax:888-870-4935
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8105101YP2500X
NC101YS0200X
NC1748101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112229Medicaid