Provider Demographics
NPI:1174262539
Name:KOMIVES, ALICIA MARIE (LISW-S)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:KOMIVES
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2317
Mailing Address - Country:US
Mailing Address - Phone:419-973-6118
Mailing Address - Fax:
Practice Address - Street 1:705 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2317
Practice Address - Country:US
Practice Address - Phone:419-973-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI12011871041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical