MEDICARE: MRS. ALICIA DOUGLAS HART MMFT, MDIV, LMFTS

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	106H00000X	Marriage & Family Therapist	7937	SC
2	106H00000X	Marriage & Family Therapist	6382	SC
3	106H00000X	Marriage & Family Therapist	4696	SC

General Provider Information

NPI Number	:	1861948192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICIA DOUGLAS HART MMFT, MDIV, LMFTS

Provider Business Mailing Address
First Line	:	160 QUARRY ROAD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-4129
Country	:	US
Telephone Number	:	864-621-9475
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 QUARRY ROAD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-4129
Country	:	US
Telephone Number	:	864-621-9475
Fax Number	:	864-751-5788

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

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	05/13/2024

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