Provider Demographics
NPI:1194565101
Name:VANLIERE, ALICIA JADE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:JADE
Last Name:VANLIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8009 N IONIA RD
Mailing Address - Street 2:
Mailing Address - City:VERMONTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49096-9780
Mailing Address - Country:US
Mailing Address - Phone:269-744-1886
Mailing Address - Fax:517-323-9531
Practice Address - Street 1:8009 N IONIA RD
Practice Address - Street 2:
Practice Address - City:VERMONTVILLE
Practice Address - State:MI
Practice Address - Zip Code:49096-9780
Practice Address - Country:US
Practice Address - Phone:269-744-1886
Practice Address - Fax:517-323-9531
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI6801115986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker