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General NPI Number Information
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NPI Number | 1447776679
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Entity Type | Individual
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Provider Name | AMBER NICKERSON LISW-CP, LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 720 GRACERN RD STE 120
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City | COLUMBIA
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State | SC
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Zip | 29210-7657
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Country | US
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Telephone | 803-296-2191
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Fax | 803-551-1252
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Provider Business Mailing Address
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Address Line | 1122 LADY ST OFC 239
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City | COLUMBIA
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State | SC
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Zip | 29201-3489
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Country | US
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Telephone | 803-855-1068
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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 | C013446
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11712
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License Number State | SC
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