Provider Demographics
NPI:1881044915
Name:HARVEY, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:HARVEY
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 1:609 VIRGINIA AVE NE
Mailing Address - Street 2:APT 8203
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-5106
Mailing Address - Country:US
Mailing Address - Phone:770-662-0249
Mailing Address - Fax:
Practice Address - Street 1:6020 DAWSON BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1229
Practice Address - Country:US
Practice Address - Phone:770-662-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004581101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor