Healthcare Provider Details

I. General information

NPI: 1073326369
Provider Name (Legal Business Name): ALICIA DENNISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 INDUSTRIAL PARK RD
MAXWELTON WV
24957-8066
US

IV. Provider business mailing address

409 CEDAR AVE
HINTON WV
25951-2607
US

V. Phone/Fax

Practice location:
  • Phone: 304-497-0500
  • Fax:
Mailing address:
  • Phone: 304-308-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: