Provider Demographics
NPI:1194563197
Name:MCCONKEY, ALICIA ANNE (LMSW-CC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANNE
Last Name:MCCONKEY
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 GRIFFIN RD APT 1
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2852
Mailing Address - Country:US
Mailing Address - Phone:207-991-1288
Mailing Address - Fax:
Practice Address - Street 1:1010 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2616
Practice Address - Country:US
Practice Address - Phone:207-990-1666
Practice Address - Fax:207-990-1688
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC23651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health