Healthcare Provider Details

I. General information

NPI: 1730470600
Provider Name (Legal Business Name): ALISIA LOUISE DULANEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 BROOKDALE DR
STATESVILLE NC
28677-4107
US

IV. Provider business mailing address

515 BROOKDALE DR
STATESVILLE NC
28677-4107
US

V. Phone/Fax

Practice location:
  • Phone: 704-380-3620
  • Fax: 704-380-3623
Mailing address:
  • Phone: 704-380-3623
  • Fax: 704-380-3623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1041C0700X
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006032
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: