Provider Demographics
NPI:1275272585
Name:MCINNIS, AMY E (LPC NCC PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:LPC NCC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2552
Mailing Address - Country:US
Mailing Address - Phone:803-201-1458
Mailing Address - Fax:
Practice Address - Street 1:1703 RICHLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2635
Practice Address - Country:US
Practice Address - Phone:803-254-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3736101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional