Provider Demographics
NPI:1285272104
Name:KULBOK, AMY CL (LPC, MACC, BC-TMH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CL
Last Name:KULBOK
Suffix:
Gender:F
Credentials:LPC, MACC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 E WHITE ST STE E
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4526
Mailing Address - Country:US
Mailing Address - Phone:803-322-6116
Mailing Address - Fax:
Practice Address - Street 1:146 E WHITE ST STE E
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4526
Practice Address - Country:US
Practice Address - Phone:803-322-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health