Provider Demographics
NPI:1376272468
Name:LICEA, ALEXANDRIA D (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:D
Last Name:LICEA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 STEPHENS PL STE 400A
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2167
Mailing Address - Country:US
Mailing Address - Phone:830-282-7980
Mailing Address - Fax:
Practice Address - Street 1:1325 N 63RD ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4111
Practice Address - Country:US
Practice Address - Phone:254-300-7591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX602191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical