Provider Demographics
NPI:1861741530
Name:CLOUGH, AMANDA VANCE (LISW-CP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:VANCE
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PIEDMONT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1836
Mailing Address - Country:US
Mailing Address - Phone:803-327-2012
Mailing Address - Fax:
Practice Address - Street 1:448 LAKESHORE PKWY
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4264
Practice Address - Country:US
Practice Address - Phone:803-327-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC120861041C0700X
NCP0069451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical