Healthcare Provider Details

I. General information

NPI: 1306002019
Provider Name (Legal Business Name): AMY LANIER DATLA LCMHCS, LMHC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY LANIER GUMPERT LMHC, CAP, NCC

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MOUNT OLIVE TER
ASHEVILLE NC
28804-2987
US

IV. Provider business mailing address

3 MOUNT OLIVE TER
ASHEVILLE NC
28804-2987
US

V. Phone/Fax

Practice location:
  • Phone: 813-808-1956
  • Fax: 888-977-1272
Mailing address:
  • Phone: 813-808-1956
  • Fax: 888-977-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8831
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2809
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: