Provider Demographics
NPI:1720707482
Name:RICKS, AMY HALLING (MS EDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:HALLING
Last Name:RICKS
Suffix:
Gender:F
Credentials:MS EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2062 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2936
Mailing Address - Country:US
Mailing Address - Phone:435-363-6480
Mailing Address - Fax:
Practice Address - Street 1:2062 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2936
Practice Address - Country:US
Practice Address - Phone:435-363-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT689344103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool