Provider Demographics
NPI:1851721021
Name:ANDERSON, AMY ROSEMARY (LCSW, LMSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ROSEMARY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 ASHFORD WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-9201
Mailing Address - Country:US
Mailing Address - Phone:803-207-4904
Mailing Address - Fax:
Practice Address - Street 1:8601 UNIVERSITY EAST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4353
Practice Address - Country:US
Practice Address - Phone:704-597-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSW.9530104100000X
NCC0092281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker