Healthcare Provider Details

I. General information

NPI: 1164575155
Provider Name (Legal Business Name): AMANDA LEIGH KIRBY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA LEIGH MICHELICH LPC

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 HORSE PEN CREEK RD STE 104
GREENSBORO NC
27410-8388
US

IV. Provider business mailing address

2509 DAWNING DR
GREENSBORO NC
27410-8724
US

V. Phone/Fax

Practice location:
  • Phone: 336-457-0827
  • Fax:
Mailing address:
  • Phone: 336-457-0827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5421
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5421
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5421
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: