Provider Demographics
NPI:1104315472
Name:DE VORE, AMY DANIELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DANIELLE
Last Name:DE VORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12703 LILAC STONE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-5682
Mailing Address - Country:US
Mailing Address - Phone:832-503-2355
Mailing Address - Fax:
Practice Address - Street 1:12703 LILAC STONE CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-5682
Practice Address - Country:US
Practice Address - Phone:832-503-2355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX516041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical