Provider Demographics
NPI:1699863761
Name:CHINLUND, ALICIA L (MA LPA LPC NCC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:L
Last Name:CHINLUND
Suffix:
Gender:F
Credentials:MA LPA LPC NCC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:LOPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCC
Mailing Address - Street 1:109 TEAL CT
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460
Mailing Address - Country:US
Mailing Address - Phone:910-308-7270
Mailing Address - Fax:888-728-0060
Practice Address - Street 1:1995 NC HWY 172
Practice Address - Street 2:UNIT B
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460
Practice Address - Country:US
Practice Address - Phone:910-327-0800
Practice Address - Fax:888-728-0060
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7104101YP2500X, 101YM0800X
NC1229103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107168Medicaid