Provider Demographics
NPI:1851866610
Name:COLLIER, ALICIA MICHELLE
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MICHELLE
Last Name:COLLIER
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:PO BOX 746096
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6096
Mailing Address - Country:US
Mailing Address - Phone:773-352-1515
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:2420 STATE ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62205-2321
Practice Address - Country:US
Practice Address - Phone:618-318-8809
Practice Address - Fax:618-615-4205
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2016025824101YP2500X
MO2016025824101YP2500X
IL180.012415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional