Provider Demographics
NPI:1558806919
Name:ALCANCIA, ALFONSO (LCSW CANDIDATE)
Entity Type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:
Last Name:ALCANCIA
Suffix:
Gender:M
Credentials:LCSW CANDIDATE
Other - Prefix:MR
Other - First Name:ALFONSO
Other - Middle Name:
Other - Last Name:ALCANCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW CANDIDATE
Mailing Address - Street 1:9502 S I-35 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160
Mailing Address - Country:US
Mailing Address - Phone:405-334-9430
Mailing Address - Fax:405-767-6285
Practice Address - Street 1:7301 BROADWAY EXT
Practice Address - Street 2:STE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9045
Practice Address - Country:US
Practice Address - Phone:405-767-1126
Practice Address - Fax:405-767-6285
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health