Provider Demographics
NPI:1417562893
Name:BIVINS, ALICIA DANIELLE (LMSW CAADC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:DANIELLE
Last Name:BIVINS
Suffix:
Gender:F
Credentials:LMSW CAADC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:DORTCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 WASHINGTON AVE STE 368
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1378
Mailing Address - Country:US
Mailing Address - Phone:616-765-8136
Mailing Address - Fax:
Practice Address - Street 1:41 WASHINGTON AVE STE 368
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1378
Practice Address - Country:US
Practice Address - Phone:616-765-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801107571104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker