Provider Demographics
NPI:1205321676
Name:HICKEY, AMANDA NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:HICKEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 KOALA DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8835
Mailing Address - Country:US
Mailing Address - Phone:850-387-5083
Mailing Address - Fax:
Practice Address - Street 1:2520 ALEXANDER DR STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7194
Practice Address - Country:US
Practice Address - Phone:479-373-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012252101YM0800X
FLMH14429101YM0800X
ARP2505021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health