Provider Demographics
NPI:1679852511
Name:HUANG, ALICE (LCSW, LISW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:LCSW, LISW
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 4975
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87196-4975
Mailing Address - Country:US
Mailing Address - Phone:206-790-9963
Mailing Address - Fax:
Practice Address - Street 1:404 11TH ST SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2988
Practice Address - Country:US
Practice Address - Phone:206-790-9963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-074941041C0700X
CA274881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical