Provider Demographics
NPI:1952748386
Name:HUNTER, ALICE GEORGIA
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:GEORGIA
Last Name:HUNTER
Suffix:
Gender:F
Credentials:
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 150
Mailing Address - Street 2:ATTN: BEHAVIORAL HEALTH
Mailing Address - City:SCAMMON BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99662-0150
Mailing Address - Country:US
Mailing Address - Phone:907-558-5856
Mailing Address - Fax:907-558-5705
Practice Address - Street 1:128 FRONT ST
Practice Address - Street 2:
Practice Address - City:SCAMMON BAY
Practice Address - State:AK
Practice Address - Zip Code:99662-0129
Practice Address - Country:US
Practice Address - Phone:907-558-5856
Practice Address - Fax:907-558-5705
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKBHA II172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020986Medicaid