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NPI Code Detail

MEDICARE: ALICIA LANDRUM LPC

MEDICARE: ALICIA LANDRUM LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorA1504062AR
2101YP2500XProfessional CounselorP1807088AR
3171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245454347
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA LANDRUM LPC
Provider Business Mailing Address
First Line : 4301 W MARKHAM ST # 783
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-7101
Country : US
Telephone Number : 501-686-8000
Fax Number : 501-526-5601
Provider Business Practice Location Address
First Line : 4224 SHUFFIELD DR
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-7211
Country : US
Telephone Number : 501-526-8200
Fax Number : 501-526-5296
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2007
Last Update Date : 02/14/2024

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Directions to “ ALICIA LANDRUM LPC” Practice Location

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