Provider Demographics
NPI:1588998686
Name:MAISONAVE, ALICIA PEREZ (LPC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:PEREZ
Last Name:MAISONAVE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 CANTOR ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4643
Mailing Address - Country:US
Mailing Address - Phone:757-636-3164
Mailing Address - Fax:757-368-2839
Practice Address - Street 1:3143 MAGIC HOLLOW BLVD
Practice Address - Street 2:STE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-3077
Practice Address - Country:US
Practice Address - Phone:757-636-3164
Practice Address - Fax:757-368-2839
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional