Provider Demographics
NPI:1154554012
Name:NIENHUIS, AMY A (LISW-CP, MSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:NIENHUIS
Suffix:
Gender:F
Credentials:LISW-CP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 HARVEST MOON CT
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-9228
Mailing Address - Country:US
Mailing Address - Phone:803-754-0267
Mailing Address - Fax:
Practice Address - Street 1:3050 LEAPHART RD
Practice Address - Street 2:MT. HEBRON PASTORAL COUNSELING CENTER
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-791-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical