MEDICARE: ALICIA D MAINKA LPC, LMFT

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
1	101YP2500X	Professional Counselor	1513	MS
2	106H00000X	Marriage & Family Therapist	256	LA

General Provider Information

NPI Number	:	1477850618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA D MAINKA LPC, LMFT

Provider Business Mailing Address
First Line	:	1755 LELIA DR STE 405-701
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4828
Country	:	US
Telephone Number	:	601-456-2633
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 LELIA DR STE 405-701
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4828
Country	:	US
Telephone Number	:	601-456-2633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2011
Last Update Date	:	03/31/2026

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