Healthcare Provider Details

I. General information

NPI: 1649519190
Provider Name (Legal Business Name): MICCA NICHOLE RATLIFF M.ED, LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 OAK RIDGE CT
PRESTONSBURG KY
41653-8607
US

IV. Provider business mailing address

5666 KY ROUTE 850
HIPPO KY
41653-8334
US

V. Phone/Fax

Practice location:
  • Phone: 606-889-1602
  • Fax: 606-263-4467
Mailing address:
  • Phone: 606-358-9520
  • Fax: 606-886-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2288
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberE.2102246
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1458
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: