1740883891 NPI number — MRS. ALICIA MULDROW LISWCP, LCSW, LCAS-A

Table of content: MRS. ALICIA MULDROW LISWCP, LCSW, LCAS-A (NPI 1740883891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740883891 NPI number — MRS. ALICIA MULDROW LISWCP, LCSW, LCAS-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULDROW
Provider First Name:
ALICIA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LISWCP, LCSW, LCAS-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740883891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
135 E MAIN ST STE 213
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29730-4892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-579-8558
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 E MAIN ST STE 213
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29730-4892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-579-8558
Provider Business Practice Location Address Fax Number:
844-440-1971
Provider Enumeration Date:
11/20/2020

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: 1041C0700X , with the licence number:  C015812 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 15097 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 25548 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: LW1076 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".