Provider Demographics
NPI:1679289896
Name:BUCHANAN, AMY VISCOMI (LCMHCA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:VISCOMI
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 CORDIA CIR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-7809
Mailing Address - Country:US
Mailing Address - Phone:828-446-3469
Mailing Address - Fax:
Practice Address - Street 1:7480 WATERSIDE LOOP RD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7929
Practice Address - Country:US
Practice Address - Phone:704-483-3783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC-A18505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health