Provider Demographics
NPI:1194213132
Name:DANLEY, ALICIA NICOLE (MSW, PCAT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:NICOLE
Last Name:DANLEY
Suffix:
Gender:F
Credentials:MSW, PCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 DELTA BLUFF CV
Mailing Address - Street 2:
Mailing Address - City:WALLS
Mailing Address - State:MS
Mailing Address - Zip Code:38680-4400
Mailing Address - Country:US
Mailing Address - Phone:662-510-4660
Mailing Address - Fax:662-781-0690
Practice Address - Street 1:8900 DELTA BLUFF CV
Practice Address - Street 2:
Practice Address - City:WALLS
Practice Address - State:MS
Practice Address - Zip Code:38680-4400
Practice Address - Country:US
Practice Address - Phone:662-510-4660
Practice Address - Fax:662-781-0690
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101YA0400X
MSW6813104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker