Healthcare Provider Details

I. General information

NPI: 1245432269
Provider Name (Legal Business Name): JOYCE AMLIN MRC, LSW, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E HIGH ST
SPRINGFIELD OH
45505-1121
US

IV. Provider business mailing address

1101 E HIGH ST
SPRINGFIELD OH
45505-1121
US

V. Phone/Fax

Practice location:
  • Phone: 937-328-5300
  • Fax: 937-322-4900
Mailing address:
  • Phone: 937-328-5300
  • Fax: 937-322-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0026067
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.902802
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: