Provider Demographics
NPI:1467539890
Name:MILLARD, ALICIA ROSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ROSE
Last Name:MILLARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:ROSE
Other - Last Name:OLIVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0241
Mailing Address - Country:US
Mailing Address - Phone:760-687-5031
Mailing Address - Fax:
Practice Address - Street 1:8325 HAVEN AVE STE 209
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3894
Practice Address - Country:US
Practice Address - Phone:760-687-5031
Practice Address - Fax:310-751-5422
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA285571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health