Healthcare Provider Details

I. General information

NPI: 1932099033
Provider Name (Legal Business Name): ALICIA CAMERON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MONTGOMERY BLVD NE STE B203
ALBUQUERQUE NM
87109-1202
US

IV. Provider business mailing address

231 ALISO DR NE
ALBUQUERQUE NM
87108-1002
US

V. Phone/Fax

Practice location:
  • Phone: 505-421-0814
  • Fax:
Mailing address:
  • Phone: 505-977-6616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: