Provider Demographics
NPI:1285960666
Name:BERWICK, AMY COURTENAY (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:COURTENAY
Last Name:BERWICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3308
Mailing Address - Country:US
Mailing Address - Phone:704-953-7072
Mailing Address - Fax:
Practice Address - Street 1:1801 E 5TH ST STE 211
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3400
Practice Address - Country:US
Practice Address - Phone:704-953-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7564101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health