Provider Demographics
NPI:1194097428
Name:O'BRIEN, ALICE ROWAN (LPCMH)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:ROWAN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2556
Mailing Address - Country:US
Mailing Address - Phone:302-521-3859
Mailing Address - Fax:302-397-8277
Practice Address - Street 1:4800 LANCASTER PIKE
Practice Address - Street 2:SUSSEX COTTAGE
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-2559
Practice Address - Country:US
Practice Address - Phone:302-521-3859
Practice Address - Fax:302-397-8227
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000558101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEPC-0000558OtherSTATE OF DELAWARE