Provider Demographics
NPI:1649519190
Name:RATLIFF, MICCA NICHOLE (MED, LPCC, NCC)
Entity type:Individual
Prefix:
First Name:MICCA
Middle Name:NICHOLE
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:MED, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5666 KY ROUTE 850
Mailing Address - Street 2:
Mailing Address - City:HIPPO
Mailing Address - State:KY
Mailing Address - Zip Code:41653-8334
Mailing Address - Country:US
Mailing Address - Phone:606-358-9520
Mailing Address - Fax:606-886-0055
Practice Address - Street 1:113 OAK RIDGE CT
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-8607
Practice Address - Country:US
Practice Address - Phone:606-889-1602
Practice Address - Fax:606-263-4467
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2288101YA0400X
OHE.2102246101YA0400X
KY1458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)