Provider Demographics
NPI:1710314570
Name:COOK, AMY JENNIFER (LMSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JENNIFER
Last Name:COOK
Suffix:
Gender:F
Credentials:LMSW
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 1090
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-1090
Mailing Address - Country:US
Mailing Address - Phone:843-857-0111
Mailing Address - Fax:
Practice Address - Street 1:103 NORTH KEMPER ST
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:SC
Practice Address - Zip Code:29563
Practice Address - Country:US
Practice Address - Phone:843-759-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLW1015Medicaid
SCLW1015Medicaid
SCSC20971850Medicare PIN