Provider Demographics
NPI:1588828974
Name:DUDLEY, ALICIA MARIE (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:MARIE
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:271 FORT RICHARDSON AVE
Mailing Address - Street 2:GOODFELLOW AFB
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76908-4901
Mailing Address - Country:US
Mailing Address - Phone:325-654-3122
Mailing Address - Fax:325-654-5161
Practice Address - Street 1:271 FORT RICHARDSON AVE
Practice Address - Street 2:GOODFELLOW AFB
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76908-4901
Practice Address - Country:US
Practice Address - Phone:325-654-3122
Practice Address - Fax:325-654-5161
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1153481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical