Healthcare Provider Details

I. General information

NPI: 1598633133
Provider Name (Legal Business Name): MRS. CHRISTINA ELLEN ALICEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 BEN HILL AVE SE
CAIRO GA
39828-3529
US

IV. Provider business mailing address

1310 BEN HILL AVE SE
CAIRO GA
39828-3529
US

V. Phone/Fax

Practice location:
  • Phone: 229-216-0531
  • Fax:
Mailing address:
  • Phone: 229-216-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: