Provider Demographics
NPI:1184974446
Name:SLATER, ALICIA MARIE (LMFT)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MARIE
Last Name:SLATER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:D LO
Mailing Address - State:MS
Mailing Address - Zip Code:39062-0147
Mailing Address - Country:US
Mailing Address - Phone:601-454-9966
Mailing Address - Fax:
Practice Address - Street 1:505 SECOND ST
Practice Address - Street 2:
Practice Address - City:PELAHATCHIE
Practice Address - State:MS
Practice Address - Zip Code:39145-3044
Practice Address - Country:US
Practice Address - Phone:601-854-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0315106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist