Provider Demographics
NPI:1114604162
Name:DECAIRE, ALLYCIA (IBCLC)
Entity Type:Individual
Prefix:
First Name:ALLYCIA
Middle Name:
Last Name:DECAIRE
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37034-3222
Mailing Address - Country:US
Mailing Address - Phone:931-309-9248
Mailing Address - Fax:
Practice Address - Street 1:1488 JOHN WINDROW RD
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37060-4021
Practice Address - Country:US
Practice Address - Phone:615-656-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL-311929174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN