Healthcare Provider Details

I. General information

NPI: 1871990101
Provider Name (Legal Business Name): AMY KENNEDY-RICKMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BONNIE BLVD
HUNTINGTON WV
25705-3066
US

IV. Provider business mailing address

6731 COUNTY ROAD 15
CHESAPEAKE OH
45619-8029
US

V. Phone/Fax

Practice location:
  • Phone: 304-733-0036
  • Fax: 304-736-4835
Mailing address:
  • Phone: 304-638-6050
  • Fax: 304-736-4835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2144
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: