Healthcare Provider Details

I. General information

NPI: 1417485756
Provider Name (Legal Business Name): ALICIA RENE SHIVER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA R STEVENS LPCC

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 MOWRY AVE STE 400
FREMONT CA
94538-1730
US

IV. Provider business mailing address

1725 LAFAYETTE DR NE
ALBUQUERQUE NM
87106-1003
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-8040
  • Fax:
Mailing address:
  • Phone: 505-697-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22613
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0186381
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: