Provider Demographics
NPI:1467111575
Name:SHONESY, ALICIA CARDINAL
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:CARDINAL
Last Name:SHONESY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 COLUMBIANA RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2139
Mailing Address - Country:US
Mailing Address - Phone:931-273-7678
Mailing Address - Fax:
Practice Address - Street 1:2081 COLUMBIANA RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-2139
Practice Address - Country:US
Practice Address - Phone:205-991-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-19-102106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALRBT-19-102OtherPROVIDER DOES NOT ACCEPT