Healthcare Provider Details

I. General information

NPI: 1891647962
Provider Name (Legal Business Name): ALICIA CLARE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/11/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6612 GULTON CT NE STE B
ALBUQUERQUE NM
87109-4407
US

IV. Provider business mailing address

1003 MARQUETTE AVE NW
ALBUQUERQUE NM
87102-1937
US

V. Phone/Fax

Practice location:
  • Phone: 505-633-7886
  • Fax: 505-521-5165
Mailing address:
  • Phone: 505-633-7886
  • Fax: 505-521-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0063
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: