Provider Demographics
NPI:1336622059
Name:WINIECKI, AMY (LCPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WINIECKI
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 1:2004 OLD FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4118
Mailing Address - Country:US
Mailing Address - Phone:443-980-9012
Mailing Address - Fax:
Practice Address - Street 1:4201 NORTHVIEW DR # 104
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2604
Practice Address - Country:US
Practice Address - Phone:877-203-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2018-10-19
Deactivation Date:2018-10-11
Deactivation Code:
Reactivation Date:2018-10-19
Provider Licenses
StateLicense IDTaxonomies
MDLC8755101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional