Provider Demographics
NPI:1366617151
Name:POWELL, ALICIA MARIE
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MARIE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OCEANGATE STE 550
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4379
Mailing Address - Country:US
Mailing Address - Phone:562-435-2287
Mailing Address - Fax:562-435-3128
Practice Address - Street 1:100 OCEANGATE STE 550
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4379
Practice Address - Country:US
Practice Address - Phone:562-435-2287
Practice Address - Fax:562-435-3128
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical