Basic Information
| Provider Information | |||||||||
| NPI: | 1689063380 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FUNES | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | MARGARITA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, CYT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19. E MARKET STREET | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036217121 | ||||||||
| FaxNumber: | 7036217121 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 E.MARKET STREET | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036217121 | ||||||||
| FaxNumber: | 7036217121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2015 | ||||||||
| LastUpdateDate: | 01/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904008724 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.