Provider Demographics
NPI:1619015989
Name:COMBS, AMY GAIL (LISW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:GAIL
Last Name:COMBS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:GAIL
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:731 E MAIN ST
Mailing Address - Street 2:UNIT 13
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640
Mailing Address - Country:US
Mailing Address - Phone:740-286-8789
Mailing Address - Fax:740-286-8789
Practice Address - Street 1:731 E MAIN ST
Practice Address - Street 2:UNIT 13
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640
Practice Address - Country:US
Practice Address - Phone:740-286-8789
Practice Address - Fax:740-286-8789
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00101531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical