Provider Demographics
NPI:1679083273
Name:ARZAMENDI, AUDREY (MS, LCMHC LCAS)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:ARZAMENDI
Suffix:
Gender:F
Credentials:MS, LCMHC LCAS
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:IWERKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCMHC, LCAS
Mailing Address - Street 1:3304 WICKSLOW RD APT 6
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-0948
Mailing Address - Country:US
Mailing Address - Phone:910-265-1719
Mailing Address - Fax:
Practice Address - Street 1:200 TARPON TRL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5287
Practice Address - Country:US
Practice Address - Phone:910-938-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11376101YM0800X, 101YP2500X
NCLC20465101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)