Provider Demographics
NPI:1376008961
Name:GEATHERS, AMBER VICTORIA (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:VICTORIA
Last Name:GEATHERS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3769
Mailing Address - Country:US
Mailing Address - Phone:843-670-3412
Mailing Address - Fax:
Practice Address - Street 1:700 N PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3769
Practice Address - Country:US
Practice Address - Phone:843-670-3412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2021-07-16
Deactivation Date:2020-12-03
Deactivation Code:
Reactivation Date:2021-07-15
Provider Licenses
StateLicense IDTaxonomies
SC103621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical