Provider Demographics
NPI:1477850618
Name:MAINKA, ALICIA D (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:D
Last Name:MAINKA
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 S PEAR ORCHARD RD STE 106
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4859
Mailing Address - Country:US
Mailing Address - Phone:601-456-2633
Mailing Address - Fax:
Practice Address - Street 1:1210 POLK ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5024
Practice Address - Country:US
Practice Address - Phone:601-456-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health