MEDICARE: AMIE STELLA HOPPER LCAS, LCMHCS, CCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	3362-A	NC
2	101YP2500X	Professional Counselor	10409	NC
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	3362	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3362A	OTHER	NC	NCSAPPB

General Provider Information

NPI Number	:	1083047476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIE STELLA HOPPER LCAS, LCMHCS, CCS

Provider Business Mailing Address
First Line	:	11709 FRUEHAUF DR STE 114
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-7285
Country	:	US
Telephone Number	:	704-769-9789
Fax Number	:

Provider Business Practice Location Address
First Line	:	11709 FRUEHAUF DR STE 114
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-7285
Country	:	US
Telephone Number	:	704-769-9789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	10/04/2023

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