Provider Demographics
NPI:1114640547
Name:TYNER, ALICIA MARIE (LCSWA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:TYNER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MARIE
Other - Last Name:MAULDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5751 CRENSHAW DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2200
Mailing Address - Country:US
Mailing Address - Phone:910-237-8337
Mailing Address - Fax:
Practice Address - Street 1:1101 ARSENAL AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5331
Practice Address - Country:US
Practice Address - Phone:910-237-8337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0183321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical