Provider Demographics
NPI:1891715462
Name:BARNES, AMY MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:BARNES
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 1:5 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORT
Mailing Address - State:NC
Mailing Address - Zip Code:28762-7829
Mailing Address - Country:US
Mailing Address - Phone:828-724-4206
Mailing Address - Fax:
Practice Address - Street 1:486 SPAULDING RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5212
Practice Address - Country:US
Practice Address - Phone:828-652-5444
Practice Address - Fax:828-652-5837
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103016Medicaid