Provider Demographics
NPI:1942338439
Name:PATRICK, AMY LOUISE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LOUISE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 EAST CHURCHVILLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:410-893-4600
Mailing Address - Fax:
Practice Address - Street 1:5310 HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-2232
Practice Address - Country:US
Practice Address - Phone:410-893-4600
Practice Address - Fax:410-569-0094
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9611101YP2500X
MDLC12597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional