Provider Demographics
NPI:1376968743
Name:ALICIA DIANE BARNES LCSW
Entity Type:Organization
Organization Name:ALICIA DIANE BARNES LCSW
Other - Org Name:GRACE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-353-2201
Mailing Address - Street 1:718 W MCCARTY ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-1544
Mailing Address - Country:US
Mailing Address - Phone:573-353-2201
Mailing Address - Fax:573-636-5881
Practice Address - Street 1:718 W MCCARTY ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-1544
Practice Address - Country:US
Practice Address - Phone:573-353-2201
Practice Address - Fax:573-636-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0047601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1881604676Medicaid
MO1881604676Medicaid