Provider Demographics
NPI:1861003006
Name:TERRIACA, ALIVIA MICHELLE (LMHC)
Entity Type:Individual
Prefix:
First Name:ALIVIA
Middle Name:MICHELLE
Last Name:TERRIACA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 POINTER LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-4631
Mailing Address - Country:US
Mailing Address - Phone:352-502-5686
Mailing Address - Fax:
Practice Address - Street 1:650 AVENUE K NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4032
Practice Address - Country:US
Practice Address - Phone:863-294-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health