Provider Demographics
NPI:1407191018
Name:KOPPY, ALICIA
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:KOPPY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4275 EL CAJON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1293
Mailing Address - Country:US
Mailing Address - Phone:619-283-9624
Mailing Address - Fax:
Practice Address - Street 1:4275 EL CAJON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1293
Practice Address - Country:US
Practice Address - Phone:619-283-9624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94907106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist