Healthcare Provider Details

I. General information

NPI: 1417485756
Provider Name (Legal Business Name): ALICIA RENE SHIVER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA R STEVENS

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 PENNSYLVANIA ST NE STE E
ALBUQUERQUE NM
87110-3650
US

IV. Provider business mailing address

1725 LAFAYETTE DR NE
ALBUQUERQUE NM
87106-1003
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-4400
  • Fax:
Mailing address:
  • Phone: 505-697-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0186381
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: