Provider Demographics
NPI:1629556766
Name:O'BRYAN, ALICIA WASSENICH (LSW, LCDC III)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:WASSENICH
Last Name:O'BRYAN
Suffix:
Gender:F
Credentials:LSW, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 HOPELAND ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3420
Mailing Address - Country:US
Mailing Address - Phone:937-535-8124
Mailing Address - Fax:937-222-7657
Practice Address - Street 1:257 HOPELAND ST BLDG B
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3420
Practice Address - Country:US
Practice Address - Phone:937-535-8124
Practice Address - Fax:937-222-7657
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.162351101YA0400X
OHS.2207896104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)