Provider Demographics
NPI:1437479995
Name:MITCHELL-WASHINGTON, AMY (LPC, LPCS)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:MITCHELL-WASHINGTON
Suffix:
Gender:F
Credentials:LPC, LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BAMERT STREET
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483
Mailing Address - Country:US
Mailing Address - Phone:843-469-2048
Mailing Address - Fax:
Practice Address - Street 1:605 W 5TH NORTH ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6164
Practice Address - Country:US
Practice Address - Phone:843-469-2048
Practice Address - Fax:843-884-0016
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4596101YP2500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251S00000XAgenciesCommunity/Behavioral Health