Healthcare Provider Details

I. General information

NPI: 1477128155
Provider Name (Legal Business Name): ALICIA CONING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W VISTA WAY STE 407
VISTA CA
92083-5714
US

IV. Provider business mailing address

2275 HOSP WAY APT E
CARLSBAD CA
92008-6859
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1092
  • Fax:
Mailing address:
  • Phone: 302-278-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12238
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: