Provider Demographics
NPI:1982728184
Name:AMUNDSEN, PATTIE BURNS (LPC)
Entity Type:Individual
Prefix:MS
First Name:PATTIE
Middle Name:BURNS
Last Name:AMUNDSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 FORESTVIEW DR.
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104
Mailing Address - Country:US
Mailing Address - Phone:336-659-8244
Mailing Address - Fax:
Practice Address - Street 1:6315 TOBACCOVILLE RD.
Practice Address - Street 2:
Practice Address - City:TOBACCOVILLE
Practice Address - State:NC
Practice Address - Zip Code:27050
Practice Address - Country:US
Practice Address - Phone:336-924-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC 2853101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCLPC-2853OtherLICENSED PROF COUNSELOR
NCLPC-2853Medicare UPIN