Provider Demographics
NPI:1265809875
Name:NICHOLSON, AMY CHARLOTTE (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CHARLOTTE
Last Name:NICHOLSON
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 1:146 BROOK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8810
Mailing Address - Country:US
Mailing Address - Phone:850-420-6752
Mailing Address - Fax:
Practice Address - Street 1:146 BROOK HOLLOW DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8810
Practice Address - Country:US
Practice Address - Phone:850-420-6752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11437104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker