Provider Demographics
NPI:1164618385
Name:POLIARD, ALICIA (PHD, LMFT, CFLE)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:POLIARD
Suffix:
Gender:F
Credentials:PHD, LMFT, CFLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E ROBINSON ST STE 250
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5955
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 E ROBINSON ST STE 250
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5955
Practice Address - Country:US
Practice Address - Phone:407-423-3327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2020-12-30
Deactivation Date:2012-01-26
Deactivation Code:
Reactivation Date:2015-11-10
Provider Licenses
StateLicense IDTaxonomies
NY001262106H00000X
FLMT3373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist