Provider Demographics
NPI:1003168592
Name:LURRY, ALICIA MONIQUE (LPC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MONIQUE
Last Name:LURRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MONIQUE
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:8171 PARKLAND
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1116
Mailing Address - Country:US
Mailing Address - Phone:313-282-7567
Mailing Address - Fax:
Practice Address - Street 1:8171 PARKLAND
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48239
Practice Address - Country:US
Practice Address - Phone:313-282-7567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional