Provider Demographics
NPI:1861829087
Name:THOMAS, AMY L (LPC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LOGAN DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3010
Mailing Address - Country:US
Mailing Address - Phone:864-933-8624
Mailing Address - Fax:843-326-4799
Practice Address - Street 1:115 LOGAN DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-3010
Practice Address - Country:US
Practice Address - Phone:843-291-8404
Practice Address - Fax:843-326-4799
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6514101Y00000X, 101YM0800X, 101YP2500X
SC5707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid