Healthcare Provider Details

I. General information

NPI: 1285190025
Provider Name (Legal Business Name): AMANDA ELIZABETH FLORY LCSW, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

5964 SANDFORD RD
WILSON NC
27896-8000
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-7722
  • Fax:
Mailing address:
  • Phone: 252-230-5813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC011552
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: