Provider Demographics
NPI:1356804231
Name:MCENTIRE, AMBER JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:JEAN
Last Name:MCENTIRE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-0015
Mailing Address - Country:US
Mailing Address - Phone:229-516-2748
Mailing Address - Fax:
Practice Address - Street 1:2016 E PINETREE BLVD
Practice Address - Street 2:STE A
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757
Practice Address - Country:US
Practice Address - Phone:229-236-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0095031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical