Healthcare Provider Details

I. General information

NPI: 1295442283
Provider Name (Legal Business Name): MIKHAELA ELIZABETH AMICK MA, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 WASHINGTON ST W
CHARLESTON WV
25302-1333
US

IV. Provider business mailing address

611 SPRING ST
SAINT ALBANS WV
25177-3017
US

V. Phone/Fax

Practice location:
  • Phone: 304-202-1699
  • Fax:
Mailing address:
  • Phone: 304-963-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: