Provider Demographics
NPI:1821641242
Name:RUNYAN, ALICIA ANTOINETTE (LCSW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANTOINETTE
Last Name:RUNYAN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N TENAYA WAY STE 309
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0645
Mailing Address - Country:US
Mailing Address - Phone:725-222-0263
Mailing Address - Fax:725-262-5630
Practice Address - Street 1:7221 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1619
Practice Address - Country:US
Practice Address - Phone:702-212-3008
Practice Address - Fax:702-933-3064
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9752-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical