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NPI Code Detail

MEDICARE: ALICIA CHILDRESS LCDC

MEDICARE: ALICIA CHILDRESS LCDC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor17600TX

General Provider Information

NPI Number : 1295699809
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA CHILDRESS LCDC
Provider Business Mailing Address
First Line : 950 N 4TH ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5436
Country : US
Telephone Number : 800-446-8253
Fax Number : 903-234-1639
Provider Business Practice Location Address
First Line : 950 N 4TH ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5436
Country : US
Telephone Number : 800-446-8253
Fax Number : 903-234-1639
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2025
Last Update Date : 12/10/2025

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Directions to “ ALICIA CHILDRESS LCDC” Practice Location

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