Provider Demographics
NPI:1497265367
Name:WILLIAMS, ALICIA (PSYD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MCCASLIN BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9701
Mailing Address - Country:US
Mailing Address - Phone:303-955-4871
Mailing Address - Fax:
Practice Address - Street 1:400 S MCCASLIN BLVD STE 212
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-9701
Practice Address - Country:US
Practice Address - Phone:303-955-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004630103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist