Healthcare Provider Details

I. General information

NPI: 1356844823
Provider Name (Legal Business Name): ALICIA D KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 MAYFIELD RD APT 686
MAYFIELD HTS OH
44124-2222
US

IV. Provider business mailing address

6811 MAYFIELD RD APT 686
MAYFIELD HTS OH
44124-2222
US

V. Phone/Fax

Practice location:
  • Phone: 520-431-6457
  • Fax:
Mailing address:
  • Phone: 520-431-6457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number150731
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: