Healthcare Provider Details

I. General information

NPI: 1912975475
Provider Name (Legal Business Name): ALICE-MARIE WORTHINGTON CAGS, MAEP, NAFC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 NE 36TH AVE
OCALA FL
34470-1302
US

IV. Provider business mailing address

PO BOX 831066
OCALA FL
34483-1066
US

V. Phone/Fax

Practice location:
  • Phone: 352-680-9416
  • Fax:
Mailing address:
  • Phone: 352-680-9416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24323
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8339
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: