Provider Demographics
NPI:1811225956
Name:MYRICK, AMIE CHRISTINA (MS, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:CHRISTINA
Last Name:MYRICK
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
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Mailing Address - Street 1:1205 YORK RD
Mailing Address - Street 2:SUITE 39B
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6210
Mailing Address - Country:US
Mailing Address - Phone:443-220-7922
Mailing Address - Fax:410-823-0099
Practice Address - Street 1:606 BALTIMORE AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4026
Practice Address - Country:US
Practice Address - Phone:443-220-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health