Individual
AMANDA LAVAUGHN KLUTTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LCAS, CSI
Contact information
Practice address
725 HIGHLAND AVE, WINSTON SALEM, NC 27101-4206
(336) 607-8523
(336) 727-1734
Mailing address
284 EXECUTIVE PARK DR, SUITE 100, CONCORD, NC 28025-1831
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1487
NC
104100000X
Social Worker
Primary
C006973
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487
LCAS
NC
01
—
C006973
LCSW
NC
01
—
P003739
P-LCSW
NC
Enumeration date
01/31/2007
Last updated
07/31/2013
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