Provider Demographics
NPI:1013669951
Name:LONG, ALICIA N (ALC)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:N
Last Name:LONG
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 MOORELAND RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-5471
Mailing Address - Country:US
Mailing Address - Phone:334-221-0727
Mailing Address - Fax:
Practice Address - Street 1:338 MOORELAND RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-5471
Practice Address - Country:US
Practice Address - Phone:334-221-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3793A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health