Provider Demographics
NPI:1912894031
Name:ALICEA, PEDRO R (MED, LGPC, NCC)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:R
Last Name:ALICEA
Suffix:
Gender:M
Credentials:MED, LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 TIDEWATER COLONY DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2111
Mailing Address - Country:US
Mailing Address - Phone:202-642-1672
Mailing Address - Fax:
Practice Address - Street 1:2009 TIDEWATER COLONY DR STE 2A
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2111
Practice Address - Country:US
Practice Address - Phone:410-441-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16486101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health