Provider Demographics
NPI:1972851657
Name:HENINGBURG, ALICIA L (LMHC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:L
Last Name:HENINGBURG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:LASALLE HENINGBURG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:721 OAK COMMONS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4186
Mailing Address - Country:US
Mailing Address - Phone:407-518-9505
Mailing Address - Fax:407-518-9507
Practice Address - Street 1:721 OAK COMMONS BLVD STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4186
Practice Address - Country:US
Practice Address - Phone:407-518-9505
Practice Address - Fax:407-518-9507
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH11963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health