Healthcare Provider Details

I. General information

NPI: 1427449495
Provider Name (Legal Business Name): ALICIA BLACKLEY LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA MONACO

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 MAYFIELD RD STE 200
CHESTERLAND OH
44026-2567
US

IV. Provider business mailing address

8251 MAYFIELD RD STE 200
CHESTERLAND OH
44026-2567
US

V. Phone/Fax

Practice location:
  • Phone: 440-688-4308
  • Fax: 833-206-5014
Mailing address:
  • Phone: 440-490-7226
  • Fax: 833-206-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1200002
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1500014-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: