Provider Demographics
NPI:1356689301
Name:TOLBERT, AMBER WHITAKER (LCSW, LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:WHITAKER
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 MARKET ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6530
Mailing Address - Country:US
Mailing Address - Phone:864-276-1788
Mailing Address - Fax:
Practice Address - Street 1:975 MARKET ST
Practice Address - Street 2:SUITE 211
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6530
Practice Address - Country:US
Practice Address - Phone:864-276-1788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106951041C0700X
NCC0084171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical