Provider Demographics
NPI:1578976957
Name:BAINBRIDGE, ALICIA (MA - MFT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BAINBRIDGE
Suffix:
Gender:F
Credentials:MA - MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 CELESTIN CT
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-2020
Mailing Address - Country:US
Mailing Address - Phone:808-366-0117
Mailing Address - Fax:
Practice Address - Street 1:2416 CELESTIN CT
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-2020
Practice Address - Country:US
Practice Address - Phone:808-366-0117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA116487106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist