Provider Demographics
NPI:1912228016
Name:MIKUS, AMBER ROWE (MSW, LCSW, LCAS-P)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ROWE
Last Name:MIKUS
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 SAPPHIRE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9079
Mailing Address - Country:US
Mailing Address - Phone:252-830-7561
Mailing Address - Fax:252-413-0932
Practice Address - Street 1:501 PALADIN DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7826
Practice Address - Country:US
Practice Address - Phone:252-353-5346
Practice Address - Fax:252-321-7300
Is Sole Proprietor?:No
Enumeration Date:2010-06-13
Last Update Date:2015-07-20
Deactivation Date:2011-07-20
Deactivation Code:
Reactivation Date:2013-03-14
Provider Licenses
StateLicense IDTaxonomies
NCC0086741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP005816OtherNC SOCAL WORK CERTIFICATION AND LICENSURE BOARD