Provider Demographics
NPI:1619247897
Name:TRENTHAM, ALECIA
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:TRENTHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALECIA
Other - Middle Name:
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2153 E JOYCE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5285
Mailing Address - Country:US
Mailing Address - Phone:479-575-9471
Mailing Address - Fax:479-587-9392
Practice Address - Street 1:3715 N BUSINESS DR STE 104
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5287
Practice Address - Country:US
Practice Address - Phone:479-521-1532
Practice Address - Fax:479-521-9940
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator