Healthcare Provider Details

I. General information

NPI: 1639750912
Provider Name (Legal Business Name): AMANDA MARSICEK LPMT, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2021
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 HICKORY FLAT HWY
WOODSTOCK GA
30188-3081
US

IV. Provider business mailing address

9880 HICKORY FLAT HWY
WOODSTOCK GA
30188-3081
US

V. Phone/Fax

Practice location:
  • Phone: 770-687-2542
  • Fax:
Mailing address:
  • Phone: 770-687-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number16451
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: