Provider Demographics
NPI:1306848361
Name:PERRY, ALICIA (PHD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11541 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-5943
Mailing Address - Country:US
Mailing Address - Phone:251-625-6233
Mailing Address - Fax:251-625-1482
Practice Address - Street 1:28311 N MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7074
Practice Address - Country:US
Practice Address - Phone:251-625-6233
Practice Address - Fax:251-625-1482
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3665103TC2200X
AL1394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD293890OtherMAMSI
AL51534800OtherBCBSOF AL