Alicia Renee Costner, BCABA

Primary specialty

Assistant Behavior AnalystTaxonomy code 106E00000X

License

0-19-9516 Issued in NU

Practice address

1698 Hwy 160 W.
Ste. 240
Fort Mill, SC 29708-2970

Phone

(704) 654-8599

NPI assigned

Nov 27, 2019

Last updated

Feb 10, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Alicia Renee Ide Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1619513496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13001 SEASCAPE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282787113",
            "telephone_number": "704-877-3191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1698 HWY 160 W.",
            "address_2": "STE. 240",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297082970",
            "telephone_number": "704-654-8599"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13001 Seascape Ln",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282787113",
            "country_code": "US",
            "telephone_number": "704-877-3191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COSTNER",
        "first_name": "ALICIA",
        "middle_name": "RENEE",
        "credential": "BCABA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-27",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NC",
            "license": "0-19-9516",
            "primary": false
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "NU",
            "license": "0-19-9516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICIA",
            "last_name": "IDE",
            "middle_name": "RENEE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Assistant Behavior Analyst in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Assistant Behavior Analyst in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.