Provider Demographics
NPI:1992812523
Name:MCINNIS, ALICIA ANN (LMHC)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:ANN
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:585 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-854-3320
Mailing Address - Fax:508-753-5051
Practice Address - Street 1:76 SUMMER STREET
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MD
Practice Address - Zip Code:01420
Practice Address - Country:US
Practice Address - Phone:978-343-2433
Practice Address - Fax:978-343-0791
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5284101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2220002001OtherBCBS SA
MA1306421Medicaid
MA1308785OtherMCD MH
M18684OtherBCBS MH
MA1308785OtherMCD MH