Provider Demographics
NPI:1790386175
Name:DEWELL, ALICIA (LMFT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:DEWELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 ABBOTT PL APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 RIVERSIDE DRIVE
Practice Address - Street 2:UNIT 1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039
Practice Address - Country:US
Practice Address - Phone:323-207-6479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119858101YM0800X
CA133369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA119858OtherAMFT REGISTRATION
CA133369OtherLMFT LICENSE