Healthcare Provider Details

I. General information

NPI: 1801566427
Provider Name (Legal Business Name): ALICIA FIKE LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 HIBERNIA ST
DALLAS TX
75204-2514
US

IV. Provider business mailing address

1401 ELM ST APT 3406
DALLAS TX
75202-2919
US

V. Phone/Fax

Practice location:
  • Phone: 469-343-6794
  • Fax:
Mailing address:
  • Phone: 469-343-6794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number86924
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: