Provider Demographics
NPI:1912975475
Name:WORTHINGTON, ALICE-MARIE (CAGS, MAEP, NAFC)
Entity Type:Individual
Prefix:MS
First Name:ALICE-MARIE
Middle Name:
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:CAGS, MAEP, NAFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 831066
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34483-1066
Mailing Address - Country:US
Mailing Address - Phone:352-680-9416
Mailing Address - Fax:
Practice Address - Street 1:13 NE 36TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-1302
Practice Address - Country:US
Practice Address - Phone:352-680-9416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24323101YA0400X
FLMH8339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766222000Medicaid