Provider Demographics
NPI:1629716238
Name:PERRY, ALICIA I
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:PERRY
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 SPRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-7915
Mailing Address - Country:US
Mailing Address - Phone:901-292-0821
Mailing Address - Fax:
Practice Address - Street 1:3875 SPRINGTON AVE
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-7915
Practice Address - Country:US
Practice Address - Phone:901-292-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health