Provider Demographics
NPI:1457874281
Name:AMICO, JILL (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:AMICO
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:AMICO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LLPC
Mailing Address - Street 1:805 OAKWOOD DR STE 210
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1359
Mailing Address - Country:US
Mailing Address - Phone:248-495-0977
Mailing Address - Fax:
Practice Address - Street 1:805 OAKWOOD DR STE 210
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1359
Practice Address - Country:US
Practice Address - Phone:248-495-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional