MEDICARE: AMY JILL SEITLIN LCMHCA, ATR-P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	221700000X	Art Therapist
2	101YM0800X	Mental Health Counselor	A15711	NC

General Provider Information

NPI Number	:	1578187258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY JILL SEITLIN LCMHCA, ATR-P

Provider Business Mailing Address
First Line	:	6901 FOLGER DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-5947
Country	:	US
Telephone Number	:	704-942-7888
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 FOLGER DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-5947
Country	:	US
Telephone Number	:	704-942-7888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	05/29/2020

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