Provider Demographics
NPI:1679633218
Name:ANTHONY, ALICE WELLS (GSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:WELLS
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:GSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 GOVERNMENT ST BLDG 2
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5820
Mailing Address - Country:US
Mailing Address - Phone:225-925-1741
Mailing Address - Fax:225-922-0771
Practice Address - Street 1:4615 GOVERNMENT ST BLDG 2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5820
Practice Address - Country:US
Practice Address - Phone:225-925-1741
Practice Address - Fax:225-922-0771
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6158104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker