Provider Demographics
NPI:1366160533
Name:BURDINE, ALICIA LYNN (CDCA)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LYNN
Last Name:BURDINE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11557 STATE ROUTE 774
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-8634
Mailing Address - Country:US
Mailing Address - Phone:513-516-1811
Mailing Address - Fax:
Practice Address - Street 1:104 ERIN CT
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8591
Practice Address - Country:US
Practice Address - Phone:937-393-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)