MEDICARE: AMY DICKINSON-BUSH LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC009806	GA

General Provider Information

NPI Number	:	1861109126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY DICKINSON-BUSH LPC

Provider Business Mailing Address
First Line	:	3202 POST WOODS DR APT D
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-3466
Country	:	US
Telephone Number	:	706-429-3553
Fax Number	:

Provider Business Practice Location Address
First Line	:	3202 POST WOODS DR APT D
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-3466
Country	:	US
Telephone Number	:	770-824-0384
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2022
Last Update Date	:	11/04/2022

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