Provider Demographics
NPI:1871017392
Name:FENDER, AMBER (LISW-CP/S)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:FENDER
Suffix:
Gender:F
Credentials:LISW-CP/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 SAVANNAH HWY # 281
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-2202
Mailing Address - Country:US
Mailing Address - Phone:864-431-8189
Mailing Address - Fax:
Practice Address - Street 1:1643 SAVANNAH HWY # 281
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-2202
Practice Address - Country:US
Practice Address - Phone:864-431-8189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC120971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical