Provider Demographics
NPI:1457795825
Name:ALPHONSE, FELICIA
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:
Last Name:ALPHONSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17846 LAKE CARLTON DR
Mailing Address - Street 2:APT D
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-6321
Mailing Address - Country:US
Mailing Address - Phone:213-377-8490
Mailing Address - Fax:
Practice Address - Street 1:2510 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-1106
Practice Address - Country:US
Practice Address - Phone:727-289-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 10997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health