Provider Demographics
NPI:1457304487
Name:VAWTER, AMY (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:VAWTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-0030
Mailing Address - Country:US
Mailing Address - Phone:731-642-0521
Mailing Address - Fax:731-642-1010
Practice Address - Street 1:408 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5341
Practice Address - Country:US
Practice Address - Phone:731-642-0521
Practice Address - Fax:731-642-1010
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW000000032571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3697128Medicaid
TN3697128Medicaid