Provider Demographics
NPI:1801585575
Name:LINCOLN, AMELIA P (MED, LCMHC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:P
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:MED, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:SOUTH ROYALTON
Mailing Address - State:VT
Mailing Address - Zip Code:05068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:79 SOUTH WINDSOR STREET
Practice Address - Street 2:
Practice Address - City:SOUTH ROYALTON
Practice Address - State:VT
Practice Address - Zip Code:05068
Practice Address - Country:US
Practice Address - Phone:802-763-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health