Provider Demographics
NPI:1396965489
Name:AMICK, RONALD IRVING (LPC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:IRVING
Last Name:AMICK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 WASHINGTON STREET
Mailing Address - Street 2:SUITE A2
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30519-8567
Mailing Address - Country:US
Mailing Address - Phone:770-287-1356
Mailing Address - Fax:770-287-1352
Practice Address - Street 1:621 WASHINGTON STREET
Practice Address - Street 2:SUITE A2
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30519-8567
Practice Address - Country:US
Practice Address - Phone:770-287-1356
Practice Address - Fax:770-287-1352
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional