Healthcare Provider Details

I. General information

NPI: 1689364820
Provider Name (Legal Business Name): AMY CATHERINE MINOR LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 HERITAGE CENTER DR STE 104
WAKE FOREST NC
27587-3977
US

IV. Provider business mailing address

1776 HERITAGE CENTER DR STE 104
WAKE FOREST NC
27587-3977
US

V. Phone/Fax

Practice location:
  • Phone: 919-585-5637
  • Fax:
Mailing address:
  • Phone: 919-585-5637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number10041
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: