Provider Demographics
NPI:1508921131
Name:ELDER, AMY (LISW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ELDER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5639 SOUTH BLACKMOOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8959
Mailing Address - Country:US
Mailing Address - Phone:843-359-2120
Mailing Address - Fax:
Practice Address - Street 1:5639 SOUTH BLACKMOOR DRIVE
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-8959
Practice Address - Country:US
Practice Address - Phone:843-359-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical