Provider Demographics
NPI:1861570749
Name:BITTICKS, ALYCE L (NCC, LPCS, ACS)
Entity type:Individual
Prefix:MS
First Name:ALYCE
Middle Name:L
Last Name:BITTICKS
Suffix:
Gender:F
Credentials:NCC, LPCS, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2083
Mailing Address - Country:US
Mailing Address - Phone:336-274-1237
Mailing Address - Fax:
Practice Address - Street 1:301 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2083
Practice Address - Country:US
Practice Address - Phone:336-274-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15637OtherBLUE CROSS BLUE SHIELD OF NC
NC6102402Medicaid