Provider Demographics
NPI:1659774313
Name:DERENONCOURT, ALICIA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:DERENONCOURT
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 LONGLEAF CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3618
Mailing Address - Country:US
Mailing Address - Phone:301-257-4895
Mailing Address - Fax:
Practice Address - Street 1:4305 LONGLEAF CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3618
Practice Address - Country:US
Practice Address - Phone:301-257-4895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500808371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical