Healthcare Provider Details

I. General information

NPI: 1154611051
Provider Name (Legal Business Name): ALICE HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 JENNINGS MILL RD UNIT 3200B
WATKINSVILLE GA
30677-7282
US

IV. Provider business mailing address

55 CARLTON ST
ATHENS GA
30602-1503
US

V. Phone/Fax

Practice location:
  • Phone: 706-614-8585
  • Fax:
Mailing address:
  • Phone: 706-542-8621
  • Fax: 706-583-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003861
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: