Provider Demographics
NPI:1285600551
Name:STEPHENS, ALICE A (LCSW)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:A
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 KAY LARKIN DR
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-2307
Mailing Address - Country:US
Mailing Address - Phone:386-329-3780
Mailing Address - Fax:386-329-3786
Practice Address - Street 1:330 KAY LARKIN DR
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-2307
Practice Address - Country:US
Practice Address - Phone:386-329-3780
Practice Address - Fax:386-329-3786
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW4388101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ028JOtherBC/BS
FL189743OtherWELLCARE
FL762259700OtherMEDICAID COMP. ASSESS.
FL765587800OtherMEDICAID CASE MGMT.
FLQ40800Medicare UPIN
FL765587800OtherMEDICAID CASE MGMT.
FLU4484YMedicare ID - Type Unspecified99262B