Basic Information
| Provider Information | |||||||||
| NPI: | 1689755332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORTHY | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 BELVEDERE RD | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288031502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282312954 | ||||||||
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| Practice Location | |||||||||
| Address1: | 68 GROVE ST | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288013204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282580031 | ||||||||
| FaxNumber: | 8282580038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5060 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 6102956 | 05 | NC | MEDICAID | 1406A | 01 | NC | BCBS NUMBER | OTHER |