Provider Demographics
NPI:1225853468
Name:EBDING, ALICIA MARIE (BA, CADC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:EBDING
Suffix:
Gender:
Credentials:BA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 GRAND CERRITOS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-4658
Mailing Address - Country:US
Mailing Address - Phone:808-649-9246
Mailing Address - Fax:
Practice Address - Street 1:1536 N BOULDER HWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4120
Practice Address - Country:US
Practice Address - Phone:702-932-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0021273101YA0400X
NV07894-PC101YA0400X
NV07943-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)