Provider Demographics
NPI:1881038347
Name:NOWACKI, AMY F (LISW-CP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:F
Last Name:NOWACKI
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 1:656 WHITE CHAPEL CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:656 WHITE CHAPEL CIR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-4351
Practice Address - Country:US
Practice Address - Phone:803-727-9854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2025-01-28
Deactivation Date:2025-01-09
Deactivation Code:
Reactivation Date:2025-01-22
Provider Licenses
StateLicense IDTaxonomies
SC101601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid