| Doctor Name: | AMY J LICATA |
| NPI Number: | 1578788642 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCC |
| License Number: | E-3478 |
| Business Practice Address: | 7695 S. County Rd. 25a Tipp City, OH - 453719215 |
| Business Phone Number: | 9376674678 |
| Business Fax Number: | 9376674963 |
| Mailing Address: | 1160 N. Heincke Rd., MIAMISBURG |
| State: | OH |
| Postal Code: | 45342 |
| Phone Number: | 9376674678 |
| Fax Number: | 9376674963 |
| NPI Enumeration Date: | 04/16/2007 |
| NPI Last Update Date: | 09/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | E-3478 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |