Provider Demographics
NPI:1114253150
Name:MORAN, ALICIA MAE (LPCC-S, LCADC-S, LPT)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MAE
Last Name:MORAN
Suffix:
Gender:F
Credentials:LPCC-S, LCADC-S, LPT
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:MAE
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC-S, LCADC-S, LPT
Mailing Address - Street 1:901 US HIGHWAY 68
Mailing Address - Street 2:STE 900
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-9188
Mailing Address - Country:US
Mailing Address - Phone:606-584-7055
Mailing Address - Fax:866-533-4929
Practice Address - Street 1:901 US HIGHWAY 68
Practice Address - Street 2:STE 900
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9188
Practice Address - Country:US
Practice Address - Phone:606-584-7055
Practice Address - Fax:866-533-4929
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165287101YA0400X
OHE-800517101YP2500X
KY172702103G00000X
KY171174400000X
KY103629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist