Healthcare Provider Details

I. General information

NPI: 1114463221
Provider Name (Legal Business Name): ALICIA MARIE AVILES-COREY IBCLC, RLC, ECE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 TUSCARORA TRL
JACKSONVILLE NC
28546-6402
US

IV. Provider business mailing address

807 TUSCARORA TRL
JACKSONVILLE NC
28546-6402
US

V. Phone/Fax

Practice location:
  • Phone: 910-408-2257
  • Fax:
Mailing address:
  • Phone: 910-408-2257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-100387
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: