Provider Demographics
NPI:1467598714
Name:MONTANEZ, AMY SANDER (DMIN, LPC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SANDER
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:DMIN, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 RICHLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2635
Mailing Address - Country:US
Mailing Address - Phone:803-254-5650
Mailing Address - Fax:803-254-0012
Practice Address - Street 1:1703 RICHLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2635
Practice Address - Country:US
Practice Address - Phone:803-254-5650
Practice Address - Fax:803-254-0012
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC613101YP2500X
SC1306106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist