Provider Demographics
NPI:1174396758
Name:STOLLER, AMY (LCMHC, NCC, MS, EDS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STOLLER
Suffix:
Gender:F
Credentials:LCMHC, NCC, MS, EDS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:SANTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4803 WHITE HORSE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9546
Mailing Address - Country:US
Mailing Address - Phone:336-337-8718
Mailing Address - Fax:
Practice Address - Street 1:4803 WHITE HORSE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9546
Practice Address - Country:US
Practice Address - Phone:336-337-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health