Provider Demographics
NPI:1477395986
Name:BROWN, AMY AUSTIN (LISW-CP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:AUSTIN
Last Name:BROWN
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 GROOMSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-7875
Mailing Address - Country:US
Mailing Address - Phone:704-524-5005
Mailing Address - Fax:
Practice Address - Street 1:370 GROOMSVILLE RD
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-7875
Practice Address - Country:US
Practice Address - Phone:704-524-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC169171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical