Provider Demographics
NPI:1043671621
Name:MERCER, ALICIA M
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:MERCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 MARKETPLACE BLVD
Mailing Address - Street 2:STE 130-626
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5747
Mailing Address - Country:US
Mailing Address - Phone:404-558-6758
Mailing Address - Fax:404-600-6694
Practice Address - Street 1:3645 MARKETPLACE BLVD
Practice Address - Street 2:STE 130-626
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5747
Practice Address - Country:US
Practice Address - Phone:404-558-6758
Practice Address - Fax:404-600-6694
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC08400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional