Provider Demographics
NPI:1275991390
Name:PENNINGTON, AMBER LOUISE (LMSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LOUISE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 EAGLE NEST RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-5515
Mailing Address - Country:US
Mailing Address - Phone:864-706-2348
Mailing Address - Fax:
Practice Address - Street 1:1425 JOHN B WHITE BLVD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3919
Practice Address - Country:US
Practice Address - Phone:864-582-5431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7049104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker