Provider Demographics
NPI:1609162403
Name:ENLOW, AMANDA CAROLINE YOUNG (MRC, LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CAROLINE YOUNG
Last Name:ENLOW
Suffix:
Gender:F
Credentials:MRC, LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CAROLINE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MRC, LPC-I
Mailing Address - Street 1:5240 NORWAY LN
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8398
Mailing Address - Country:US
Mailing Address - Phone:803-216-1604
Mailing Address - Fax:
Practice Address - Street 1:115 STONE VILLAGE DR STE E
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6489
Practice Address - Country:US
Practice Address - Phone:803-216-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5516101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC322842Medicaid