Provider Demographics
NPI:1205321676
Name:HICKEY, AMANDA NICOLE (LMHC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:HICKEY
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 1:310 CORAL GABLES ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-3277
Mailing Address - Country:US
Mailing Address - Phone:185-038-7508
Mailing Address - Fax:
Practice Address - Street 1:310 CORAL GABLES ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-3277
Practice Address - Country:US
Practice Address - Phone:185-038-7508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health