Provider Demographics
NPI:1407362601
Name:ALICEA, CHRESENCIA DEIDRA
Entity Type:Individual
Prefix:
First Name:CHRESENCIA
Middle Name:DEIDRA
Last Name:ALICEA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHRESENCIA
Other - Middle Name:DEIDRA
Other - Last Name:ALICEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAMFT
Mailing Address - Street 1:1419 ATHENS RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-5111
Mailing Address - Country:US
Mailing Address - Phone:302-753-9650
Mailing Address - Fax:
Practice Address - Street 1:5201 W WOODMILL DR STE 31
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4068
Practice Address - Country:US
Practice Address - Phone:302-753-9650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFA-0000009106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty