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Individual

ALICE A. STEPHENS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
L.C.S.W.

Contact information

Practice address
330 KAY LARKIN DR, PALATKA, FL 32177-2307
(386) 329-3780
(386) 329-3786
Mailing address
330 KAY LARKIN DR, PALATKA, FL 32177-2307
(386) 329-3780
(386) 329-3786

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
SW4388
FL
1041C0700X
Clinical Social Worker
Primary
SW4388
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
189743
WELLCARE
FL
01
762259700
MEDICAID COMP. ASSESS.
FL
01
765587800
MEDICAID CASE MGMT.
FL
01
Z028J
BC/BS
FL
Enumeration date
02/27/2006
Last updated
06/17/2008
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