1326199068 NPI number — MS. ALICIA RENAE MILTON LPC

Table of content: MS. ALICIA RENAE MILTON LPC (NPI 1326199068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326199068 NPI number — MS. ALICIA RENAE MILTON LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILTON
Provider First Name:
ALICIA
Provider Middle Name:
RENAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EVANS
Provider Other First Name:
ALICIA
Provider Other Middle Name:
RENAE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326199068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 CORPORATE HILL DR., SUITE 330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-4528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-954-7470
Provider Business Mailing Address Fax Number:
501-954-7420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 EXECUTIVE CT STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-526-8008
Provider Business Practice Location Address Fax Number:
501-526-8047
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  P0406025 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com