Provider Demographics
NPI:1215419106
Name:MAXWELL, ALICIA MICHELLE (LMHC, MASTER CASAC)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MICHELLE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LMHC, MASTER CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50D VILLAGE II DR
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1517
Mailing Address - Country:US
Mailing Address - Phone:585-228-0625
Mailing Address - Fax:
Practice Address - Street 1:50D VILLAGE II DR
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1517
Practice Address - Country:US
Practice Address - Phone:585-228-0625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34546101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)