Provider Demographics
NPI:1336428325
Name:ALICEA, JOANNA PAMELA (PHD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:PAMELA
Last Name:ALICEA
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:MENENDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2791 GLENVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-4207
Mailing Address - Country:US
Mailing Address - Phone:678-907-2338
Mailing Address - Fax:
Practice Address - Street 1:2791 GLENVALLEY DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-4207
Practice Address - Country:US
Practice Address - Phone:678-907-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95227101YP2500X, 101YP2500X
GALPC015297101YP2500X
TX39441103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional