Healthcare Provider Details

I. General information

NPI: 1265630347
Provider Name (Legal Business Name): AMPARO PENNY LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VILLAGE LN STE 3
ASHEVILLE NC
28803-2617
US

IV. Provider business mailing address

4032 DUTCH COVE RD
CANTON NC
28716-9183
US

V. Phone/Fax

Practice location:
  • Phone: 828-708-9955
  • Fax:
Mailing address:
  • Phone: 919-522-2498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6616
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: