Healthcare Provider Details

I. General information

NPI: 1487567517
Provider Name (Legal Business Name): AMIE L KILCOYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 CHASE RUN
NORTHVILLE MI
48167-9362
US

IV. Provider business mailing address

320 CHASE RUN
NORTHVILLE MI
48167-9362
US

V. Phone/Fax

Practice location:
  • Phone: 586-345-2483
  • Fax:
Mailing address:
  • Phone: 586-345-2483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025187
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: