Provider Demographics
NPI:1417201310
Name:TETTEH, ALICIA (ASW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:TETTEH
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 COLLEY AVE # 6101
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1144
Mailing Address - Country:US
Mailing Address - Phone:980-288-5486
Mailing Address - Fax:704-247-5355
Practice Address - Street 1:2301 COLLEY AVE # 6101
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1144
Practice Address - Country:US
Practice Address - Phone:980-288-5486
Practice Address - Fax:704-247-5355
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0100481041C0700X
VA09040176431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical