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General NPI Number Information
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NPI Number | 1609182534
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Entity Type | Organization
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Legal Business Name | AMW FOUNDATION
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 907 HAY ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5366
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Country | US
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Telephone | 919-802-1739
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Fax | 919-850-2325
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Provider Business Mailing Address
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Address Line | 3209 GRESHAM LAKE RD SUITE 113
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City | RALEIGH
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State | NC
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Zip | 27615-3757
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Country | US
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Telephone | 919-850-2155
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Fax | 919-850-2325
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. CHET WEST
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Credential |
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Telephone | 919-850-2155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6507
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License Number State | NC
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