MEDICARE: MS. AMY MITCHELL-WASHINGTON LPC, LPCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4596	SC

General Provider Information

NPI Number	:	1437479995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY MITCHELL-WASHINGTON LPC, LPCS

Provider Business Mailing Address
First Line	:	201 BAMERT STREET
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483
Country	:	US
Telephone Number	:	843-469-2048
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 W 5TH NORTH ST
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6164
Country	:	US
Telephone Number	:	843-469-2048
Fax Number	:	843-884-0016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	04/13/2020

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