Provider Demographics
NPI:1679895551
Name:HOSTINSKY, AMY BETH (LLMSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:BETH
Last Name:HOSTINSKY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22720 WOODWARD AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2920
Mailing Address - Country:US
Mailing Address - Phone:248-399-8032
Mailing Address - Fax:
Practice Address - Street 1:22720 WOODWARD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2920
Practice Address - Country:US
Practice Address - Phone:248-399-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
324500000X
MI68010937691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility