Provider Demographics
NPI:1992100994
Name:MINER, AMBER BLACKWOOD (MED, LCMHC, LPC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:BLACKWOOD
Last Name:MINER
Suffix:
Gender:F
Credentials:MED, LCMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-1303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300C GIDNEY ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-6822
Practice Address - Country:US
Practice Address - Phone:704-484-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9199OtherSOUTH CAROLINA BOARD OF LICENSED PROFESSIONAL COUNSELORS
NC11198OtherNORTH CAROLINA BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELORS