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General NPI Number Information
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NPI Number | 1356804231
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Entity Type | Individual
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Provider Name | AMBER JEAN MCENTIRE LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 2016 E PINETREE BLVD STE A
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City | THOMASVILLE
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State | GA
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Zip | 31757
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Country | US
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Telephone | 229-236-3002
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15
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City | CAMILLA
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State | GA
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Zip | 31730-0015
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Country | US
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Telephone | 229-516-2748
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW009503
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License Number State | GA
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