Provider Demographics
NPI:1790448603
Name:HALICKY, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HALICKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 20TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3747
Mailing Address - Country:US
Mailing Address - Phone:304-218-2023
Mailing Address - Fax:304-218-2026
Practice Address - Street 1:32 20TH ST STE 500
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3747
Practice Address - Country:US
Practice Address - Phone:304-218-2023
Practice Address - Fax:304-218-2026
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)