Provider Demographics
NPI:1619033891
Name:MCCORMICK, ALICESON (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:ALICESON
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38045
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0536
Mailing Address - Country:US
Mailing Address - Phone:803-817-7837
Mailing Address - Fax:803-324-4644
Practice Address - Street 1:2241 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9288
Practice Address - Country:US
Practice Address - Phone:803-817-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC76661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical