Provider Demographics
NPI:1972081743
Name:AMICK, DENISE MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:AMICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 E LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-6052
Mailing Address - Country:US
Mailing Address - Phone:850-324-2428
Mailing Address - Fax:850-366-9012
Practice Address - Street 1:1010 N 12TH AVE STE 305
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3370
Practice Address - Country:US
Practice Address - Phone:850-324-2428
Practice Address - Fax:850-366-9012
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH16204OtherLICENSED MENTAL HEALTH COUNSELOR FLORIDA