Healthcare Provider Details

I. General information

NPI: 1699083071
Provider Name (Legal Business Name): AMY MARIE KIRCHNER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ORANGE ST
SAINT AUGUSTINE FL
32084-3633
US

IV. Provider business mailing address

40 ORANGE ST
SAINT AUGUSTINE FL
32084-3633
US

V. Phone/Fax

Practice location:
  • Phone: 904-547-7481
  • Fax:
Mailing address:
  • Phone: 904-547-7481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH13664
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: