Provider Demographics
NPI:1144046558
Name:VAN SICKLE, EMILY (MS, CRC, LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:VAN SICKLE
Suffix:
Gender:F
Credentials:MS, CRC, LPC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:HUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CRC, LPC
Mailing Address - Street 1:1504 SANTA ROSA RD RM 208
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5109
Mailing Address - Country:US
Mailing Address - Phone:804-288-6272
Mailing Address - Fax:
Practice Address - Street 1:1504 SANTA ROSA RD RM 208
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5109
Practice Address - Country:US
Practice Address - Phone:804-288-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health