Provider Demographics
NPI:1366927998
Name:GILLETTE, AMY F (LPCA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:F
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 JAMESTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-5801
Mailing Address - Country:US
Mailing Address - Phone:704-506-6764
Mailing Address - Fax:
Practice Address - Street 1:4614 WILGROVE MINT HILL RD STE B4
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3547
Practice Address - Country:US
Practice Address - Phone:704-447-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-29
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14293101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor