Provider Demographics
NPI:1861948192
Name:HART, ALICIA DOUGLAS (MMFT, MDIV, LMFTS)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:DOUGLAS
Last Name:HART
Suffix:
Gender:F
Credentials:MMFT, MDIV, LMFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 QUARRY ROAD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4129
Mailing Address - Country:US
Mailing Address - Phone:864-621-9475
Mailing Address - Fax:
Practice Address - Street 1:160 QUARRY ROAD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-4129
Practice Address - Country:US
Practice Address - Phone:864-621-9475
Practice Address - Fax:864-751-5788
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7937106H00000X
SC6382106H00000X
SC4696106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist