Healthcare Provider Details

I. General information

NPI: 1306848361
Provider Name (Legal Business Name): ALICIA PERRY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28311 N MAIN ST STE 100
DAPHNE AL
36526-7074
US

IV. Provider business mailing address

11541 COUNTY ROAD 1
FAIRHOPE AL
36532-5943
US

V. Phone/Fax

Practice location:
  • Phone: 251-625-6233
  • Fax: 251-625-1482
Mailing address:
  • Phone: 251-625-6233
  • Fax: 251-625-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1394
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3665
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: