Healthcare Provider Details

I. General information

NPI: 1164342341
Provider Name (Legal Business Name): ALICIA KATHLEEN CAMERON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA KATHLEEN MARTINEZ

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9378 SUNSET RIDGE DR NE
ROCKFORD MI
49341-7122
US

IV. Provider business mailing address

5920 BARCROFT DR SW
WYOMING MI
49418-9315
US

V. Phone/Fax

Practice location:
  • Phone: 269-599-1506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095954
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: