Healthcare Provider Details

I. General information

NPI: 1477850618
Provider Name (Legal Business Name): ALICIA D MAINKA LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 LELIA DR STE 405-701
JACKSON MS
39216-4828
US

IV. Provider business mailing address

1755 LELIA DR STE 405-701
JACKSON MS
39216-4828
US

V. Phone/Fax

Practice location:
  • Phone: 601-456-2633
  • Fax:
Mailing address:
  • Phone: 601-456-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1513
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number256
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: