Provider Demographics
NPI:1114463221
Name:AVILES-COREY, ALICIA MARIE (IBCLC, RLC, ECE)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:AVILES-COREY
Suffix:
Gender:F
Credentials:IBCLC, RLC, ECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 TUSCARORA TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6402
Mailing Address - Country:US
Mailing Address - Phone:910-408-2257
Mailing Address - Fax:
Practice Address - Street 1:807 TUSCARORA TRL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6402
Practice Address - Country:US
Practice Address - Phone:910-408-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL-100387174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN