Provider Demographics
NPI:1366643405
Name:CANFIELD, ALICIA BRITTANY NOEL (BS IN PROGRESS)
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:BRITTANY NOEL
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:BS IN PROGRESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7818 OLYMPIC WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4825
Mailing Address - Country:US
Mailing Address - Phone:916-879-4691
Mailing Address - Fax:
Practice Address - Street 1:24321 COUNTY ROAD 96
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-753-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMHAL910006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health