Provider Demographics
NPI:1699283622
Name:ROYALS, AMY MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:ROYALS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 REAGAN MEAD LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4374
Mailing Address - Country:US
Mailing Address - Phone:630-878-0488
Mailing Address - Fax:
Practice Address - Street 1:3326 DURHAM CHAPEL HILL BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6239
Practice Address - Country:US
Practice Address - Phone:630-878-0488
Practice Address - Fax:919-695-0077
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0060031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical