Provider Demographics
NPI:1972058675
Name:HEINCELMAN, AMY LOUISE (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:HEINCELMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 EXECUTIVE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2944
Mailing Address - Country:US
Mailing Address - Phone:248-978-8697
Mailing Address - Fax:248-282-7372
Practice Address - Street 1:2011 EXECUTIVE HILLS DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2944
Practice Address - Country:US
Practice Address - Phone:248-978-8697
Practice Address - Fax:248-282-7372
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010621961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical