Provider Demographics
NPI:1417293556
Name:OLIVARES, ALICIA CARMEN (MS, PHD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:CARMEN
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 B ST
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-5025
Mailing Address - Country:US
Mailing Address - Phone:321-442-6665
Mailing Address - Fax:800-883-7015
Practice Address - Street 1:21 B ST
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-5025
Practice Address - Country:US
Practice Address - Phone:321-442-6665
Practice Address - Fax:800-883-7015
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 171M00000X
FLMH11233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty