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NPI Code Detail

MEDICARE: ALICIA RENE' RICKETTS LPC

MEDICARE: ALICIA RENE' RICKETTS LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor7618NC

General Provider Information

NPI Number : 1821312653
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA RENE' RICKETTS LPC
Provider Business Mailing Address
First Line : 10130 MALLARD CREEK RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-6001
Country : US
Telephone Number : 980-201-1495
Fax Number :
Provider Business Practice Location Address
First Line : 10130 MALLARD CREEK RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-6001
Country : US
Telephone Number : 980-201-1495
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2010
Last Update Date : 10/29/2024

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Directions to “ ALICIA RENE' RICKETTS LPC” Practice Location

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