Provider Demographics
NPI:1194899880
Name:IRVIN, ALICIA LARA (PSYD LMFT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LARA
Last Name:IRVIN
Suffix:
Gender:F
Credentials:PSYD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 HOCHMUTH AVE BLDG 6E
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92140-5000
Mailing Address - Country:US
Mailing Address - Phone:619-398-7265
Mailing Address - Fax:
Practice Address - Street 1:3602 HOCHMUTH AVE BLDG 6E
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140-0335
Practice Address - Country:US
Practice Address - Phone:619-398-7265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist