Provider Demographics
NPI:1407089972
Name:MIKOLAITIS, ALINA ANUCCAVECH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALINA
Middle Name:ANUCCAVECH
Last Name:MIKOLAITIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:29504 WHITLEY COLLINS DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-4947
Mailing Address - Country:US
Mailing Address - Phone:323-426-4342
Mailing Address - Fax:
Practice Address - Street 1:916 N WESTERN AVE STE 205
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-2435
Practice Address - Country:US
Practice Address - Phone:310-957-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA925131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty