Provider Demographics
NPI:1740595420
Name:MAXWELL, ALICIA HUGHES
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:HUGHES
Last Name:MAXWELL
Suffix:
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 1:1929 OLD HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-6229
Mailing Address - Country:US
Mailing Address - Phone:931-627-5256
Mailing Address - Fax:
Practice Address - Street 1:201 UFFELMAN DR STE F
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2970
Practice Address - Country:US
Practice Address - Phone:931-920-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health