Provider Demographics
NPI:1144469776
Name:BAUER, AMY L (LCAS)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:BAUER
Suffix:
Gender:F
Credentials:LCAS
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Mailing Address - Street 1:284 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1894
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:5841 HIGHWAY 421 SOUTH
Practice Address - Street 2:
Practice Address - City:BUIES CREEK
Practice Address - State:NC
Practice Address - Zip Code:27506
Practice Address - Country:US
Practice Address - Phone:910-893-5727
Practice Address - Fax:910-893-6404
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1363101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112071Medicaid