Provider Demographics
NPI:1073005310
Name:CONNER, ALICE MARIE (LPC, CSAC, NCC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:MARIE
Last Name:CONNER
Suffix:
Gender:F
Credentials:LPC, CSAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 OFFICE SQUARE LN STE 202B
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3663
Mailing Address - Country:US
Mailing Address - Phone:757-754-1700
Mailing Address - Fax:
Practice Address - Street 1:249 DRIFTWOOD RD STE 202B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6827
Practice Address - Country:US
Practice Address - Phone:757-754-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health