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General NPI Number Information
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NPI Number | 1972371060
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Entity Type | Individual
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Provider Name | ALICIA MARIE ANTIUK LADC, MHRT/C
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Gender | Female
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 2323 MEDWAY RD
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City | MEDWAY
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State | ME
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Zip | 04460-3106
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Country | US
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Telephone | 207-249-0840
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Fax |
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Provider Business Mailing Address
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Address Line | 3 MAIN ST
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City | EAST MILLINOCKET
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State | ME
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Zip | 04430-1220
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Country | US
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Telephone | 207-249-0840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 35230
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LC8637
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License Number State | ME
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