Provider Demographics
NPI:1124458294
Name:ALICEA, ELVIS (LCSW)
Entity type:Individual
Prefix:MR
First Name:ELVIS
Middle Name:
Last Name:ALICEA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-8842
Mailing Address - Country:US
Mailing Address - Phone:859-274-2021
Mailing Address - Fax:
Practice Address - Street 1:700 HOPE HILL RD
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:KY
Practice Address - Zip Code:40334-7002
Practice Address - Country:US
Practice Address - Phone:859-498-5230
Practice Address - Fax:859-498-2606
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical