Provider Demographics
NPI:1578788642
Name:DUNHAM, AMY J (LPCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:LICATA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:5350 LAMME RD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-3215
Practice Address - Country:US
Practice Address - Phone:937-534-4600
Practice Address - Fax:937-522-8788
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-3478101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health