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NPI Code Detail

MEDICARE: AMY CHRIST LISW-CP

MEDICARE: AMY CHRIST LISW-CP
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
11041C0700XClinical Social Worker9795SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19795OTHERSCSC LLR

General Provider Information

NPI Number : 1134600679
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY CHRIST LISW-CP
Provider Business Mailing Address
First Line : 340 E MAIN ST STE 102
Second Line :
City : SPARTANBURG
State : SC
Zip : 29302-1987
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 340 E MAIN ST STE 102
Second Line :
City : SPARTANBURG
State : SC
Zip : 29302-1987
Country : US
Telephone Number : 864-707-2167
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2018
Last Update Date : 08/23/2018

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Directions to “ AMY CHRIST LISW-CP” Practice Location

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