Provider Demographics
NPI:1740883891
Name:MULDROW, ALICIA (LISWCP, LCSW, LCAS-A)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:MULDROW
Suffix:
Gender:F
Credentials:LISWCP, LCSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E MAIN ST STE 213
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4892
Mailing Address - Country:US
Mailing Address - Phone:803-579-8558
Mailing Address - Fax:
Practice Address - Street 1:135 E MAIN ST STE 213
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4892
Practice Address - Country:US
Practice Address - Phone:803-579-8558
Practice Address - Fax:844-440-1971
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0158121041C0700X
SC150971041C0700X
NC25548101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLW1076Medicaid