Provider Demographics
NPI:1376074765
Name:BARNICKLE, ALIYA
Entity Type:Individual
Prefix:
First Name:ALIYA
Middle Name:
Last Name:BARNICKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8747 CHARLES DAVIS RD NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:IN
Mailing Address - Zip Code:47166-8916
Mailing Address - Country:US
Mailing Address - Phone:812-736-3126
Mailing Address - Fax:
Practice Address - Street 1:7509 CHARLESTOWN PIKE
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-9623
Practice Address - Country:US
Practice Address - Phone:812-736-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)