Provider Demographics
NPI:1982239877
Name:STORY, ALICIA (LCSW-A)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:STORY
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 BOONE TRAIL EXT STE H
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3860
Mailing Address - Country:US
Mailing Address - Phone:910-223-0949
Mailing Address - Fax:
Practice Address - Street 1:109 BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5401
Practice Address - Country:US
Practice Address - Phone:910-829-9017
Practice Address - Fax:910-485-4752
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0143931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical