Provider Demographics
NPI:1356739155
Name:WATKINS, AMY MARION (LPC, CACII, LPCS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARION
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LPC, CACII, LPCS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:SUZANNE
Other - Last Name:MARION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 SEA HAWK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9044
Mailing Address - Country:US
Mailing Address - Phone:803-920-9198
Mailing Address - Fax:
Practice Address - Street 1:810 DUTCH SQUARE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7318
Practice Address - Country:US
Practice Address - Phone:803-920-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC415101YA0400X
SC5720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)