Provider Demographics
NPI:1194405449
Name:MYRICK, AMY PEARCE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:PEARCE
Last Name:MYRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:PEARCE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:CASTALIA
Mailing Address - State:NC
Mailing Address - Zip Code:27816-0006
Mailing Address - Country:US
Mailing Address - Phone:919-497-6553
Mailing Address - Fax:
Practice Address - Street 1:402 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522
Practice Address - Country:US
Practice Address - Phone:919-529-2474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0026751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical