Healthcare Provider Details

I. General information

NPI: 1003472101
Provider Name (Legal Business Name): ALICIA CAROL GREATHOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W MARKET ST
WARREN OH
44481-1017
US

IV. Provider business mailing address

357 6TH ST
CAMPBELL OH
44405-1253
US

V. Phone/Fax

Practice location:
  • Phone: 330-394-8831
  • Fax:
Mailing address:
  • Phone: 330-271-9912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA166934
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: