Provider Demographics
NPI:1841869757
Name:HYDE, ALICIA MARIE (LCSWA)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:HYDE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MARIE
Other - Last Name:HYDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-A
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1907
Mailing Address - Fax:
Practice Address - Street 1:1703 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3521
Practice Address - Country:US
Practice Address - Phone:704-818-9191
Practice Address - Fax:704-872-3782
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical