Healthcare Provider Details

I. General information

NPI: 1437160652
Provider Name (Legal Business Name): AMY B MOULDS MED, LCMHCS, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 WINDY RD STE 305
APEX NC
27502-2513
US

IV. Provider business mailing address

950 WINDY RD STE 305
APEX NC
27502-2513
US

V. Phone/Fax

Practice location:
  • Phone: 919-303-0273
  • Fax: 919-303-5986
Mailing address:
  • Phone: 919-303-0273
  • Fax: 919-303-5986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3648
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier127VT
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS PROVIDER ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: