Healthcare Provider Details

I. General information

NPI: 1942853296
Provider Name (Legal Business Name): ALICIA CARMONA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 TEMESCAL CANYON RD STE 401
CORONA CA
92883-4626
US

IV. Provider business mailing address

PO BOX 384
CHINO HILLS CA
91709-0013
US

V. Phone/Fax

Practice location:
  • Phone: 909-200-3409
  • Fax: 855-850-3354
Mailing address:
  • Phone: 909-200-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5016-R
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number111939
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: