Provider Demographics
NPI:1154056448
Name:DOUSE, ALICEA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:ALICEA
Middle Name:MICHELLE
Last Name:DOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 REDHAWK DR SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-7826
Mailing Address - Country:US
Mailing Address - Phone:912-220-4242
Mailing Address - Fax:
Practice Address - Street 1:4380 REDHAWK DR SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-7826
Practice Address - Country:US
Practice Address - Phone:912-220-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor