Provider Demographics
NPI:1952458648
Name:JOLLY, AMY ESTINGOY (MRC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ESTINGOY
Last Name:JOLLY
Suffix:
Gender:F
Credentials:MRC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:HELENE
Other - Last Name:ESTINGOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:613 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2603
Mailing Address - Country:US
Mailing Address - Phone:803-799-5008
Mailing Address - Fax:
Practice Address - Street 1:1135 CARTER ST
Practice Address - Street 2:INDEPENDENCE HOUSE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2811
Practice Address - Country:US
Practice Address - Phone:803-786-1183
Practice Address - Fax:803-735-1021
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health